Provider Demographics
NPI:1699497958
Name:BALES, MCKINSLEY
Entity type:Individual
Prefix:
First Name:MCKINSLEY
Middle Name:
Last Name:BALES
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 1:359 COMMONWEALTH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3867
Mailing Address - Country:US
Mailing Address - Phone:276-669-6331
Mailing Address - Fax:276-669-2950
Practice Address - Street 1:359 COMMONWEALTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3867
Practice Address - Country:US
Practice Address - Phone:276-669-6331
Practice Address - Fax:276-669-2950
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist