Provider Demographics
NPI:1134185960
Name:HERNANDEZ-ALLEN, ILSE P (DOM)
Entity type:Individual
Prefix:DR
First Name:ILSE
Middle Name:P
Last Name:HERNANDEZ-ALLEN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:DR
Other - First Name:ILSE
Other - Middle Name:P
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:5154 W SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1986
Mailing Address - Country:US
Mailing Address - Phone:505-573-1288
Mailing Address - Fax:
Practice Address - Street 1:5154 W SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1986
Practice Address - Country:US
Practice Address - Phone:505-573-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC011980171100000X
AZSLPA118722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No171100000XOther Service ProvidersAcupuncturist