Healthcare Provider Details

I. General information

NPI: 1003454976
Provider Name (Legal Business Name): ALLISON HAVILAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 N BEND RD STE F
CINCINNATI OH
45239-7660
US

IV. Provider business mailing address

4447 GLENHAVEN RD APT 3A
CINCINNATI OH
45238-6266
US

V. Phone/Fax

Practice location:
  • Phone: 513-389-1067
  • Fax:
Mailing address:
  • Phone: 914-382-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: