Provider Demographics
NPI:1245749423
Name:BALL, BRENDA LEE (SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:BALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 PRESIDENTIAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5173
Mailing Address - Country:US
Mailing Address - Phone:740-223-4418
Mailing Address - Fax:
Practice Address - Street 1:400 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5532
Practice Address - Country:US
Practice Address - Phone:740-223-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist