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NPI Code Detail

MEDICARE: AUDRI KAYE ALLEN

MEDICARE: AUDRI KAYE 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
1106S00000XBehavior TechnicianA450074461721MI

General Provider Information

NPI Number : 1770162307
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDRI KAYE ALLEN
Provider Business Mailing Address
First Line : 1509 W SIDNEY RD
Second Line :
City : SIDNEY
State : MI
Zip : 48885-9748
Country : US
Telephone Number : 616-232-8418
Fax Number :
Provider Business Practice Location Address
First Line : 100 E MAIN ST STE A
Second Line :
City : STANTON
State : MI
Zip : 48888-8601
Country : US
Telephone Number : 989-372-9550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2021
Last Update Date : 04/02/2021

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Directions to “ AUDRI KAYE ALLEN ” Practice Location

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