Provider Demographics
NPI:1558622050
Name:BALAY, ELIZABETH (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:BALAY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14018 ST CECELIA CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2080
Mailing Address - Country:US
Mailing Address - Phone:516-697-2933
Mailing Address - Fax:
Practice Address - Street 1:95 CUSTER AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PK
Practice Address - State:NY
Practice Address - Zip Code:11596-2302
Practice Address - Country:US
Practice Address - Phone:516-519-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
VA2202009032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist