Provider Demographics
NPI:1508446428
Name:ALLEN, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14326 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3511
Mailing Address - Country:US
Mailing Address - Phone:402-210-9983
Mailing Address - Fax:
Practice Address - Street 1:14326 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3511
Practice Address - Country:US
Practice Address - Phone:402-210-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator