Healthcare Provider Details

I. General information

NPI: 1427685908
Provider Name (Legal Business Name): ALLISON NICOLE COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 LAKESIDE DR
MAUMEE OH
43537-8528
US

IV. Provider business mailing address

4709 LAKESIDE DR
MAUMEE OH
43537-8528
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-7294
  • Fax:
Mailing address:
  • Phone: 208-819-7294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMED-PHYS-COM-LIC-162
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35C.003113
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61407823
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: