Healthcare Provider Details

I. General information

NPI: 1124508163
Provider Name (Legal Business Name): ALLYSON DOREEN ANDERSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON DOREEN MONTGOMERY M.A.

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

6700 N SUNRISE BLVD #416
GLENDALE AZ
85305
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 267-372-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP11423
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: