Provider Demographics
NPI:1457728263
Name:ALLISON, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ALLISON
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 1:816A MAHLENBROCK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DIX
Mailing Address - State:NJ
Mailing Address - Zip Code:08640-1812
Mailing Address - Country:US
Mailing Address - Phone:941-705-4949
Mailing Address - Fax:
Practice Address - Street 1:816A MAHLENBROCK AVE
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-1812
Practice Address - Country:US
Practice Address - Phone:941-705-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14080768235Z00000X
NJ41YS00995400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100687790AMedicaid