Provider Demographics
NPI:1295871572
Name:PURDUN, ALISHA MICHELLE
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHELLE
Last Name:PURDUN
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 1:1101 S 25TH ST
Mailing Address - Street 2:P.O. BOX 503
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2611
Mailing Address - Country:US
Mailing Address - Phone:660-425-7400
Mailing Address - Fax:660-425-7404
Practice Address - Street 1:1101 S 25TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2611
Practice Address - Country:US
Practice Address - Phone:660-425-7400
Practice Address - Fax:660-425-7404
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001012237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist