Provider Demographics
NPI:1699822460
Name:MYERS, ALLISON SHERIDAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:SHERIDAN
Last Name:MYERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12916 W WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3040
Mailing Address - Country:US
Mailing Address - Phone:847-638-0478
Mailing Address - Fax:
Practice Address - Street 1:12916 W WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60083-3040
Practice Address - Country:US
Practice Address - Phone:847-638-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-007727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist