Provider Demographics
NPI:1003212614
Name:ALLEN, BRIANNE (MA - CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA - CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 750366
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-0366
Mailing Address - Country:US
Mailing Address - Phone:937-638-5135
Mailing Address - Fax:
Practice Address - Street 1:1683 ELM BROOK TRAIL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-4545
Practice Address - Country:US
Practice Address - Phone:937-638-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07719235Z00000X
OHSP.09951235Z00000X
AZSLP10213235Z00000X
VA2202007639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist