Provider Demographics
NPI:1467958173
Name:PHILLIPS, ALLISON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 NE WHISPER RIDGE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6416
Mailing Address - Country:US
Mailing Address - Phone:402-515-0538
Mailing Address - Fax:402-403-5857
Practice Address - Street 1:1372 NE WHISPER RIDGE DR APT 3
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6416
Practice Address - Country:US
Practice Address - Phone:541-204-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34686235Z00000X
AK200096235Z00000X
OR16919235Z00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist