Provider Demographics
NPI:1598258329
Name:ALLEN, ALIYAH MARIE
Entity Type:Individual
Prefix:
First Name:ALIYAH
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:AU GRES
Mailing Address - State:MI
Mailing Address - Zip Code:48703-9777
Mailing Address - Country:US
Mailing Address - Phone:989-305-8828
Mailing Address - Fax:
Practice Address - Street 1:5130 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:MI
Practice Address - Zip Code:48756-9616
Practice Address - Country:US
Practice Address - Phone:989-254-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician