MEDICARE: ALLISON HEUN MSP

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	235Z00000X	Speech-Language Pathologist	13682	OH
2	235Z00000X	Speech-Language Pathologist	31693	CA

General Provider Information

NPI Number	:	1760037881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON HEUN MSP

Provider Business Mailing Address
First Line	:	10201 WATERIDGE CIR STE 450
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-5800
Country	:	US
Telephone Number	:	858-216-8837
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 N BRAND BLVD STE 100
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1221
Country	:	US
Telephone Number	:	747-286-2600
Fax Number	:

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

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	07/07/2021

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Directions to “ ALLISON HEUN MSP” Practice Location

Language	Start Address	Practice Location

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