Provider Demographics
NPI:1225261969
Name:BRACKEN, ALLISON GAYLE (MS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:GAYLE
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 CALIFORNIA AVE SW APT 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4470
Mailing Address - Country:US
Mailing Address - Phone:206-498-6668
Mailing Address - Fax:
Practice Address - Street 1:2205 N 45TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6903
Practice Address - Country:US
Practice Address - Phone:206-547-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00003787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist