Provider Demographics
NPI:1487979605
Name:BALENT, AMY LYNN (MS, CCC-SLP/L,CBIS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BALENT
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L,CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 OAK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-2949
Mailing Address - Country:US
Mailing Address - Phone:570-709-1215
Mailing Address - Fax:
Practice Address - Street 1:68 OAK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-2949
Practice Address - Country:US
Practice Address - Phone:570-709-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist