Provider Demographics
NPI:1093358475
Name:MILLER, ALLISON HEIDI (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:HEIDI
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:HEIDI
Other - Last Name:TOBASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW RINGGOLD
Mailing Address - State:PA
Mailing Address - Zip Code:17960-9309
Mailing Address - Country:US
Mailing Address - Phone:570-573-3551
Mailing Address - Fax:
Practice Address - Street 1:224 NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9080
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABB004678103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-38129OtherBACB
PABH004678OtherSTATE BOARD OF MEDICINE - BEHAVIOR SPECIALIST LICENSE