Provider Demographics
NPI:1801373618
Name:FORTIER, ALLISON (SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FORTIER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 POOL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3673
Mailing Address - Country:US
Mailing Address - Phone:848-333-0782
Mailing Address - Fax:
Practice Address - Street 1:730 POOL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3673
Practice Address - Country:US
Practice Address - Phone:848-333-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173913801Medicaid