Provider Demographics
NPI:1346089190
Name:BALLER, SENECA RYAN
Entity type:Individual
Prefix:
First Name:SENECA
Middle Name:RYAN
Last Name:BALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 W 4TH AVE APT I106
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8605
Mailing Address - Country:US
Mailing Address - Phone:712-635-7902
Mailing Address - Fax:
Practice Address - Street 1:8102 W GRANDRIDGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7157
Practice Address - Country:US
Practice Address - Phone:509-735-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist