Provider Demographics
NPI:1215373170
Name:STAFFORD, ALLYCEN R (MA, SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALLYCEN
Middle Name:R
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-1700
Mailing Address - Country:US
Mailing Address - Phone:785-650-1083
Mailing Address - Fax:
Practice Address - Street 1:108 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:KS
Practice Address - Zip Code:67546-8016
Practice Address - Country:US
Practice Address - Phone:620-585-6411
Practice Address - Fax:620-585-6504
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist