Provider Demographics
NPI:1407413263
Name:WIDMAYER, ALLISON
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:WIDMAYER
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 1:550 SOLUTIONS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3620
Mailing Address - Country:US
Mailing Address - Phone:321-639-9800
Mailing Address - Fax:
Practice Address - Street 1:550 SOLUTIONS WAY
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3620
Practice Address - Country:US
Practice Address - Phone:321-639-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician