Provider Demographics
NPI:1033989314
Name:ALLEN, KISA LASHAWN
Entity Type:Individual
Prefix:
First Name:KISA
Middle Name:LASHAWN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 SLATER ST APT 102
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2759
Mailing Address - Country:US
Mailing Address - Phone:419-787-0248
Mailing Address - Fax:
Practice Address - Street 1:1338 SLATER ST APT 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2759
Practice Address - Country:US
Practice Address - Phone:419-787-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor