Provider Demographics
NPI:1003080334
Name:MENARD, ALLYSON JANE (SLP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JANE
Last Name:MENARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:HATHAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4200
Practice Address - Fax:610-302-5618
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0001359235Z00000X
PASL009132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist