Provider Demographics
NPI:1922512987
Name:ALLEN, LEON SHAWN
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:SHAWN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S GOLIAD ST UNIT 1524
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4051
Mailing Address - Country:US
Mailing Address - Phone:214-622-1882
Mailing Address - Fax:
Practice Address - Street 1:6060 N CENTRAL EXPY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5209
Practice Address - Country:US
Practice Address - Phone:214-622-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No385H00000XRespite Care FacilityRespite Care