Provider Demographics
NPI:1427203520
Name:ALLEN, SUSAN L (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3700
Mailing Address - Country:US
Mailing Address - Phone:870-424-3266
Mailing Address - Fax:
Practice Address - Street 1:3011 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3700
Practice Address - Country:US
Practice Address - Phone:870-424-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#955235Z00000X
MD00197376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126434721Medicaid