Healthcare Provider Details

I. General information

NPI: 1962667022
Provider Name (Legal Business Name): LAURA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 W FAIDLEY AVE
GRAND ISLAND NE
68803-4109
US

IV. Provider business mailing address

3004 W FAIDLEY AVE
GRAND ISLAND NE
68803-4109
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number161
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: