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General NPI Number Information
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NPI Number | 1871867622
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Entity Type | Individual
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Provider Name | NICOLE ALLEN CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/25/2012
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 21 S PARK BLVD SUITE 21
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City | GREENWOOD
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State | IN
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Zip | 46143-8838
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Country | US
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Telephone | 317-449-2104
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Fax | 765-450-6664
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Provider Business Mailing Address
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Address Line | 700 E. FIRMIN STREET SUITE 209
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City | KOKOMO
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State | IN
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Zip | 46902-2375
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Country | US
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Telephone | 765-454-9748
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Fax | 765-450-6664
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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 | 22005496A
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License Number State | IN
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