Provider Demographics
NPI:1821738782
Name:ALLEN, TIMOTHY JORDAN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JORDAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 ROUGHRIDER BLVD APT 111
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6774
Mailing Address - Country:US
Mailing Address - Phone:208-681-5827
Mailing Address - Fax:
Practice Address - Street 1:230 3RD AVE E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5255
Practice Address - Country:US
Practice Address - Phone:701-456-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist