Provider Demographics
NPI:1669540977
Name:SUDDARD, ALLISON DOUGLAS (LAC)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:DOUGLAS
Last Name:SUDDARD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-0430
Mailing Address - Country:US
Mailing Address - Phone:303-668-9900
Mailing Address - Fax:
Practice Address - Street 1:636 KATTELL STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:303-668-9900
Practice Address - Fax:303-828-9558
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist