Healthcare Provider Details

I. General information

NPI: 1417873357
Provider Name (Legal Business Name): ALLISON KLECKER MA,SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 13TH ST
RIVERSIDE CA
92501-3505
US

IV. Provider business mailing address

PO BOX 868
RIVERSIDE CA
92502-0868
US

V. Phone/Fax

Practice location:
  • Phone: 951-826-6476
  • Fax:
Mailing address:
  • Phone: 951-826-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP34211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: