Provider Demographics
NPI:1043327901
Name:BALAZS, CARRIE LOPEZ (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LOPEZ
Last Name:BALAZS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:MARIE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:2669 N. SCENIC DR.
Mailing Address - Street 2:GERALD CHAMPION REGIONAL MEDICAL CENTER
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:575-446-5526
Mailing Address - Fax:
Practice Address - Street 1:2669 N. SCENIC DR.
Practice Address - Street 2:GERALD CHAMPION REGIONAL MEDICAL CENTER
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-446-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist