Healthcare Provider Details

I. General information

NPI: 1487100855
Provider Name (Legal Business Name): ALLISON FLETCHER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6865 GENDER RD
CANAL WNCHSTR OH
43110-8282
US

IV. Provider business mailing address

2080 CITYGATE DR
COLUMBUS OH
43219-3591
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-2150
  • Fax: 614-833-2161
Mailing address:
  • Phone: 614-445-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: