Provider Demographics
NPI:1134123045
Name:ALLISON THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:ALLISON THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:REIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MSR, CCC-SLP
Authorized Official - Phone:843-697-0396
Mailing Address - Street 1:1233 BEN SAWYER BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4577
Mailing Address - Country:US
Mailing Address - Phone:843-697-0396
Mailing Address - Fax:803-675-0787
Practice Address - Street 1:1233 BEN SAWYER BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4577
Practice Address - Country:US
Practice Address - Phone:843-697-0396
Practice Address - Fax:803-675-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3695235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4010Medicaid
SC8280Medicare PIN