Individual provider · NPI-1

Charles Balke, Psy.D.

Psychologist, Clinical · Fort Wayne, IN

NPI number1790113009

StatusActive

Last updated in NPPESJul 8, 2022

Details

NPI: 1790113009
Entity type: Individual (NPI-1)
Name: Charles Balke
Credential: Psy.D.
Sex: Male
Sole proprietor: Yes
Enumeration date: Oct 23, 2013
Certification date: Jul 8, 2022
Last updated: Jul 8, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
103TC0700X	Psychologist, Clinical	20042479A	IN	Yes

Practice location

7311a W Jefferson Blvd
Fort Wayne, IN 46804-6237

Phone 260-471-8033 · Fax 260-471-8107

Mailing address

7311a W Jefferson Blvd
Fort Wayne, IN 46804-6237

Phone 260-471-8033 · Fax 260-471-8107

Other practice locations

208 S Maple St
Pierceton, IN 46562-9086

Phone 574-594-3815 · Fax 574-594-1653

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