Individual
LAURA BALLANTYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
600 SE MILLER ST, LEES SUMMIT, MO 64063
(816) 986-1510
Mailing address
600 SE MILLER ST, LEES SUMMIT, MO 64063-4261
(816) 986-1510
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016023498
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316493828
—
MO
Enumeration date
08/26/2016
Last updated
08/31/2018
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