Provider Demographics
NPI:1790861862
Name:ABDALLAH, ALICIA JEAN (CNA, PSYCH TECH)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:CNA, PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-1063
Mailing Address - Country:US
Mailing Address - Phone:406-253-3761
Mailing Address - Fax:
Practice Address - Street 1:300 N SOMERS RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8031
Practice Address - Country:US
Practice Address - Phone:406-253-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor