Provider Demographics
NPI:1598074395
Name:ALLEN, NANCY A (SLP MA, CCC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:SLP MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 SHARON VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9301
Mailing Address - Country:US
Mailing Address - Phone:740-366-7955
Mailing Address - Fax:
Practice Address - Street 1:51 N 3RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5592
Practice Address - Country:US
Practice Address - Phone:740-349-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist