Individual
DONNA J BALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3336
(573) 785-6707
Mailing address
1110 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3336
(573) 785-6707
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2009019300
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009019300
SPEECH AND LANGUAGE PATHOLOGIST
MO
01
—
235Z00000X
SPEECH AND LANGUAGE PATHOLOGIST
MO
Enumeration date
08/19/2009
Last updated
08/19/2009
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