Healthcare Provider Details

I. General information

NPI: 1538228986
Provider Name (Legal Business Name): MRS. MARY ANN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 FREEPORT RD SUITE 25 FELDARELLI SQUARE
NEW KENSINGTON PA
15068-4669
US

IV. Provider business mailing address

237 ALUMINUM CITY TER
NEW KENSINGTON PA
15068-5079
US

V. Phone/Fax

Practice location:
  • Phone: 724-339-6631
  • Fax: 724-339-7369
Mailing address:
  • Phone: 724-339-1422
  • Fax: 724-339-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAT001024L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: