Individual
KRISTIN BALON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1230 W STATE ROAD 2, LA PORTE, IN 46350-5537
(219) 362-2145
Mailing address
1230 W. STATE ROAD 2, LA PORTE, IN 46350
(219) 362-2145
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042448A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100163580
—
IN
Enumeration date
08/22/2008
Last updated
02/18/2013
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