Provider Demographics
NPI:1346474681
Name:OVERTON, ALLYSON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:
Last Name:OVERTON
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 1:2839 E FALCON DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2154
Mailing Address - Country:US
Mailing Address - Phone:208-639-5936
Mailing Address - Fax:
Practice Address - Street 1:2839 E FALCON DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2154
Practice Address - Country:US
Practice Address - Phone:208-639-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist