Provider Demographics
NPI:1598863474
Name:BALZER, CARRIE A
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:A
Last Name:BALZER
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 1:2825 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2426
Mailing Address - Country:US
Mailing Address - Phone:513-221-0527
Mailing Address - Fax:
Practice Address - Street 1:1858 SOLUTIONS CTR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60677-1008
Practice Address - Country:US
Practice Address - Phone:513-221-0527
Practice Address - Fax:513-221-1703
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 13212355S0801X
OHCOND.2010180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant