Provider Demographics
NPI:1205278207
Name:DEROCHER, ALLISON JANE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:JANE
Last Name:DEROCHER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-7213
Mailing Address - Country:US
Mailing Address - Phone:772-216-3634
Mailing Address - Fax:
Practice Address - Street 1:1213 W 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7213
Practice Address - Country:US
Practice Address - Phone:772-216-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 6004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist