Provider Demographics
NPI:1912172206
Name:BALLEW, DARLENE WELTON (MA)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:WELTON
Last Name:BALLEW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:DARLENE
Other - Middle Name:YVONNE
Other - Last Name:WELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:24810 BURNT PINE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1973
Mailing Address - Country:US
Mailing Address - Phone:239-462-4021
Mailing Address - Fax:
Practice Address - Street 1:24810 BURNT PINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1973
Practice Address - Country:US
Practice Address - Phone:239-462-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1221231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist