Provider Demographics
NPI:1386202620
Name:VANSICKLE, ALLISON ANNE (BS-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:VANSICKLE
Suffix:
Gender:F
Credentials:BS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59888 PINE CREST DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9471
Mailing Address - Country:US
Mailing Address - Phone:574-309-2206
Mailing Address - Fax:
Practice Address - Street 1:59888 PINE CREST DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9471
Practice Address - Country:US
Practice Address - Phone:574-309-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004250A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist