Healthcare Provider Details

I. General information

NPI: 1568324176
Provider Name (Legal Business Name): JODY VAN ALLEN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 RHODES AVE
WOONSOCKET RI
02895-2899
US

IV. Provider business mailing address

9 TEAL LN
CUMBERLAND RI
02864-2724
US

V. Phone/Fax

Practice location:
  • Phone: 774-306-1931
  • Fax:
Mailing address:
  • Phone: 774-306-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP01342
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: