Provider Demographics
NPI:1639301179
Name:SOPHER, ALISON DAWN (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:DAWN
Last Name:SOPHER
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:MRS
Other - First Name:ALISON
Other - Middle Name:DAWN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACCC/SLP
Mailing Address - Street 1:2400 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1305
Mailing Address - Country:US
Mailing Address - Phone:724-846-8255
Mailing Address - Fax:724-647-1232
Practice Address - Street 1:2400 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1305
Practice Address - Country:US
Practice Address - Phone:724-846-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006153L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023932040001Medicaid