Provider Demographics
NPI:1780072132
Name:STODDARD, ALLISON MICHELLE (MA,CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:MICHELLE
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4826
Mailing Address - Country:US
Mailing Address - Phone:209-675-0854
Mailing Address - Fax:
Practice Address - Street 1:373 W NEES AVE APT 251
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6161
Practice Address - Country:US
Practice Address - Phone:209-675-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist