Provider Demographics
NPI:1417523200
Name:SANDOVAL, ALLISON LOUISE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LOUISE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5995
Mailing Address - Country:US
Mailing Address - Phone:208-654-6161
Mailing Address - Fax:208-473-7320
Practice Address - Street 1:316 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5995
Practice Address - Country:US
Practice Address - Phone:208-654-6161
Practice Address - Fax:208-473-7320
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist