Provider Demographics
NPI:1245823939
Name:ALLEN, DODI RENA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DODI
Middle Name:RENA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 FAIRVIEW ST APT 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3236
Mailing Address - Country:US
Mailing Address - Phone:757-846-4544
Mailing Address - Fax:
Practice Address - Street 1:3105 AMERICAN LEGION RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5653
Practice Address - Country:US
Practice Address - Phone:757-774-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009863235Z00000X
VA2203000386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist