| Doctor Name: | MRS. DEBRA KIM BALES |
| NPI Number: | 1851601918 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., C.C.C., SLP |
| License Number: | 004530-1 |
| Business Practice Address: | 1165 Saltaire Way Mattituck, NY - 119523019 |
| Business Phone Number: | 6312987220 |
| Business Fax Number: | 6312987220 |
| Mailing Address: | 1165 Saltaire Way, MATTITUCK |
| State: | NY |
| Postal Code: | 119523019 |
| Phone Number: | 6312987220 |
| Fax Number: | 6312987220 |
| NPI Enumeration Date: | 10/07/2010 |
| NPI Last Update Date: | 10/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 004530-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |