Provider Demographics
NPI:1811661150
Name:ALLEN, THERESA MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6110
Mailing Address - Country:US
Mailing Address - Phone:360-533-0633
Mailing Address - Fax:
Practice Address - Street 1:303 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6110
Practice Address - Country:US
Practice Address - Phone:360-533-0633
Practice Address - Fax:360-533-2541
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61200202231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist