Healthcare Provider Details

I. General information

NPI: 1679224141
Provider Name (Legal Business Name): ALLISON NICOLE ALDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SIMPSON RD W STE 103
LENOIR CITY TN
37771-6685
US

IV. Provider business mailing address

1475 SIMPSON RD W STE 103
LENOIR CITY TN
37771-6685
US

V. Phone/Fax

Practice location:
  • Phone: 865-441-8078
  • Fax: 877-440-0682
Mailing address:
  • Phone: 865-441-8078
  • Fax: 877-440-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-78997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: