Healthcare Provider Details

I. General information

NPI: 1639750730
Provider Name (Legal Business Name): MISS HUNTER ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15857 W BONITOS DR
GOODYEAR AZ
85395-7571
US

IV. Provider business mailing address

1346 S TERRACE RD
TEMPE AZ
85281-5839
US

V. Phone/Fax

Practice location:
  • Phone: 623-224-1214
  • Fax:
Mailing address:
  • Phone: 602-501-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: