Provider Demographics
NPI:1033586946
Name:JANSSEN, ALLISON R (BS, RBT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 N GATEWAY DR
Mailing Address - Street 2:UNIT 336
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9840
Mailing Address - Country:US
Mailing Address - Phone:920-851-9883
Mailing Address - Fax:
Practice Address - Street 1:5160 SUNSET LN
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4230
Practice Address - Country:US
Practice Address - Phone:801-935-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist