Healthcare Provider Details

I. General information

NPI: 1427190172
Provider Name (Legal Business Name): DEBORAH L ALLEN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BROOK RD
RICHMOND VA
23220-1215
US

IV. Provider business mailing address

2737 MAURICE WALK CT
GLEN ALLEN VA
23060-4427
US

V. Phone/Fax

Practice location:
  • Phone: 804-273-6656
  • Fax:
Mailing address:
  • Phone: 804-262-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202003043
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: