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General NPI Number Information
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NPI Number | 1316141476
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Entity Type | Individual
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Provider Name | MARY ELENA ALLEN M.ED.,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 227 HAMPTON SHORES DR
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City | HAMPTON
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State | GA
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Zip | 30228-2762
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Country | US
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Telephone | 678-479-6002
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Fax | 678-479-9630
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Provider Business Mailing Address
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Address Line | 227 HAMPTON SHORES DRIVE
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City | HAMPTON
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State | GA
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Zip | 30228
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Country | US
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Telephone | 678-479-6002
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Fax | 678-479-9630
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP 005884
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License Number State | GA
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