Healthcare Provider Details

I. General information

NPI: 1841597531
Provider Name (Legal Business Name): ALLISON GARDNER BASHE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VIP DR SUITE 310
WEXFORD PA
15090-6932
US

IV. Provider business mailing address

117 VIP DR SUITE 310
WEXFORD PA
15090-6932
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3905
  • Fax: 724-934-3906
Mailing address:
  • Phone: 724-934-3905
  • Fax: 724-934-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016975
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: