Provider Demographics
NPI:1912204751
Name:INGRAM, ALLISON
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DAVIDS CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1301
Mailing Address - Country:US
Mailing Address - Phone:732-274-1527
Mailing Address - Fax:
Practice Address - Street 1:18 DAVIDS CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1301
Practice Address - Country:US
Practice Address - Phone:732-274-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00098800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00028670OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION CERTIFICATION
NJ41YS00098800OtherSTATE LICENSE