Individual
GEORGE HERBERT BALLANTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
266 OLD CHURCH RD, CORRALES, NM 87048-8657
(505) 890-9064
Mailing address
266 OLD CHURCH RD, CORRALES, NM 87048-8657
(505) 890-9064
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
771
NM
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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