Provider Demographics
NPI:1669613832
Name:ALLEN THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:ALLEN THERAPY SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:904-465-0178
Mailing Address - Street 1:660 SPANISH WELLS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8926
Mailing Address - Country:US
Mailing Address - Phone:904-465-0178
Mailing Address - Fax:904-770-5596
Practice Address - Street 1:2103 GILMORE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3211
Practice Address - Country:US
Practice Address - Phone:904-465-0178
Practice Address - Fax:904-770-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5457235Z00000X
261QM1300X
FLEXEMPT252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000468800Medicaid
FL000712000Medicaid