Provider Demographics
NPI:1194357590
Name:ALLEN, ALEISHA L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEISHA
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 95TH ST # 107
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5792
Mailing Address - Country:US
Mailing Address - Phone:917-819-5047
Mailing Address - Fax:
Practice Address - Street 1:633 W 5TH ST OFC 2876B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2005
Practice Address - Country:US
Practice Address - Phone:512-399-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028828-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist