Provider Demographics
NPI:1689880858
Name:ALLEN, OKIE EARL (BCHIS)
Entity Type:Individual
Prefix:MR
First Name:OKIE
Middle Name:EARL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 LAMPLIGHTER COURT
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5817
Mailing Address - Country:US
Mailing Address - Phone:715-832-0679
Mailing Address - Fax:
Practice Address - Street 1:616 LAMPLIGHTER CT
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703
Practice Address - Country:US
Practice Address - Phone:715-579-3008
Practice Address - Fax:715-834-7112
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42818500Medicaid