Individual
ELISA YCOCO BALLESTEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS SLP
Contact information
Practice address
1991 E WHITEHOUSE CANYON RD, GREEN VALLEY, AZ 85614-0522
(520) 625-4581
Mailing address
PO BOX 547, GREEN VALLEY, AZ 85622-0547
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLPL5252
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028399
—
AZ
Enumeration date
02/06/2007
Last updated
05/28/2015
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