Provider Demographics
NPI:1508269788
Name:HAVILAND, ALLISON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 PULSAR PL
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2079
Mailing Address - Country:US
Mailing Address - Phone:614-734-7777
Mailing Address - Fax:419-884-1891
Practice Address - Street 1:8425 PULSAR PL
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2079
Practice Address - Country:US
Practice Address - Phone:614-734-7777
Practice Address - Fax:419-884-1891
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist