Provider Demographics
NPI:1235444381
Name:ALLEN, KIM DUTRO
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:DUTRO
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9804
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-0804
Mailing Address - Country:US
Mailing Address - Phone:336-294-8091
Mailing Address - Fax:336-294-8432
Practice Address - Street 1:328 PUMPKIN RUN RD
Practice Address - Street 2:
Practice Address - City:PURLEAR
Practice Address - State:NC
Practice Address - Zip Code:28665-9203
Practice Address - Country:US
Practice Address - Phone:336-973-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC740236BMedicaid