Provider Demographics
NPI:1801046800
Name:ALLEN, KRISTI MALLICOTE (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MALLICOTE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3957
Mailing Address - Country:US
Mailing Address - Phone:205-265-2057
Mailing Address - Fax:205-275-2388
Practice Address - Street 1:904 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3957
Practice Address - Country:US
Practice Address - Phone:205-265-2057
Practice Address - Fax:205-265-2388
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0927231H00000X
AL0927A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter