Healthcare Provider Details

I. General information

NPI: 1720510118
Provider Name (Legal Business Name): ALISON DINSMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568 ALLYSON LN
MARRERO LA
70072-6167
US

IV. Provider business mailing address

2568 ALLYSON LN
MARRERO LA
70072-6167
US

V. Phone/Fax

Practice location:
  • Phone: 941-777-0471
  • Fax:
Mailing address:
  • Phone: 941-777-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB327358
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-16859
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: