MEDICARE: KATIE ALLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-19-34642	CA

General Provider Information

NPI Number	:	1093284192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ALLEN

Provider Business Mailing Address
First Line	:	3162 NEWBERRY DR STE 10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1567
Country	:	US
Telephone Number	:	408-826-4828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3162 NEWBERRY DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1500
Country	:	US
Telephone Number	:	408-826-4828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	03/14/2023

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Directions to “ KATIE ALLEN ” Practice Location

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