Provider Demographics
NPI:1740401827
Name:VENABLE, ALLISON R (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:VENABLE
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 1:2312 VALENCIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2362
Mailing Address - Country:US
Mailing Address - Phone:318-237-4632
Mailing Address - Fax:
Practice Address - Street 1:2312 VALENCIA BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2362
Practice Address - Country:US
Practice Address - Phone:318-237-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist