Provider Demographics
NPI:1609064088
Name:ALLEN, REBECCA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ALLEN-BURGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:348 GORDON PALMER HALL HACKBERRY LANE
Mailing Address - Street 2:THE UNIVERSITY OF ALABAMA
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0001
Mailing Address - Country:US
Mailing Address - Phone:205-348-9891
Mailing Address - Fax:205-348-7520
Practice Address - Street 1:348 GORDON PALMER HALL HACKBERRY LANE
Practice Address - Street 2:THE UNIVERSITY OF ALABAMA
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:205-348-9891
Practice Address - Fax:205-348-7520
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL904103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging