Healthcare Provider Details

I. General information

NPI: 1871867622
Provider Name (Legal Business Name): NICOLE ALLEN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S PARK BLVD SUITE 21
GREENWOOD IN
46143-8838
US

IV. Provider business mailing address

700 E. FIRMIN STREET SUITE 209
KOKOMO IN
46902-2375
US

V. Phone/Fax

Practice location:
  • Phone: 317-449-2104
  • Fax: 765-450-6664
Mailing address:
  • Phone: 765-454-9748
  • Fax: 765-450-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22005496A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: