Provider Demographics
NPI:1912214875
Name:O'BRIEN, ALLISON OWEN (MA, CCC-SLP/LIC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:OWEN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP/LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1680
Mailing Address - Country:US
Mailing Address - Phone:315-445-4010
Mailing Address - Fax:315-445-4060
Practice Address - Street 1:3049 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1680
Practice Address - Country:US
Practice Address - Phone:315-445-4010
Practice Address - Fax:315-445-4060
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014527-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist