Provider Demographics
NPI:1083024335
Name:LAGANKE, ALLYSON (MED, EDS, NCSP)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:
Last Name:LAGANKE
Suffix:
Gender:F
Credentials:MED, EDS, NCSP
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 963
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5963
Mailing Address - Country:US
Mailing Address - Phone:216-337-5966
Mailing Address - Fax:
Practice Address - Street 1:555 BARBER RD
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-1799
Practice Address - Country:US
Practice Address - Phone:330-753-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3102366103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool