Provider Demographics
NPI:1649468315
Name:TUPPER, ALLISON (SLP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TUPPER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:KRIVARCHKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC, SLP
Mailing Address - Street 1:890 N COLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8638
Mailing Address - Country:US
Mailing Address - Phone:208-323-8888
Mailing Address - Fax:208-323-8889
Practice Address - Street 1:890 N COLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8638
Practice Address - Country:US
Practice Address - Phone:208-323-8888
Practice Address - Fax:208-323-8889
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1493235Z00000X
MN10577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist