Provider Demographics
NPI:1205974698
Name:ALLEN, JOAN LEE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5200
Mailing Address - Country:US
Mailing Address - Phone:812-283-1930
Mailing Address - Fax:
Practice Address - Street 1:580 WESTPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2949
Practice Address - Country:US
Practice Address - Phone:270-766-5370
Practice Address - Fax:270-766-5375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0096231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist