Provider Demographics
NPI:1023463023
Name:ALLEN, MICHAELA
Entity type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:
Last Name:ALLEN
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 1:553 HARTFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2150
Mailing Address - Country:US
Mailing Address - Phone:860-774-5195
Mailing Address - Fax:860-779-3628
Practice Address - Street 1:553 HARTFORD PIKE
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2150
Practice Address - Country:US
Practice Address - Phone:860-774-5195
Practice Address - Fax:860-779-3628
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT451237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist