Provider Demographics
NPI:1578878989
Name:PORTILLO, ALLISON KATHLEEN (MA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:KATHLEEN
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14794 STONEY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8793
Mailing Address - Country:US
Mailing Address - Phone:303-702-0091
Mailing Address - Fax:303-702-0108
Practice Address - Street 1:519 EMERY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5544
Practice Address - Country:US
Practice Address - Phone:303-702-0091
Practice Address - Fax:303-702-0108
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist