Provider Demographics
NPI:1891978011
Name:ALLEN, FONDA (FOSTER PARENT)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FOSTER PARENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 N JAY ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4457
Mailing Address - Country:US
Mailing Address - Phone:602-696-2006
Mailing Address - Fax:
Practice Address - Street 1:698 N JAY ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4457
Practice Address - Country:US
Practice Address - Phone:602-696-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker