Basic Information
Provider Information | |||||||||
NPI: | 1104162171 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BALON | ||||||||
FirstName: | HEATHER | ||||||||
MiddleName: | DAWN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | AU.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 30055 NORTHWESTERN HWY | ||||||||
Address2: | STE 101 | ||||||||
City: | FARMINGTON HILLS | ||||||||
State: | MI | ||||||||
PostalCode: | 483343260 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2488654127 | ||||||||
FaxNumber: | 2488654198 | ||||||||
Practice Location | |||||||||
Address1: | 30055 NORTHWESTERN HWY | ||||||||
Address2: | SUITE 101 | ||||||||
City: | FARMINGTON HILLS | ||||||||
State: | MI | ||||||||
PostalCode: | 483343230 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2488654444 | ||||||||
FaxNumber: | 2488656161 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/20/2012 | ||||||||
LastUpdateDate: | 05/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000631 | MI | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.