MEDICARE: ALLISON THERAPEUTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	3695	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134123045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLISON THERAPEUTICS, LLC

Provider Business Mailing Address
First Line	:	1233 BEN SAWYER BLVD
Second Line	:	SUITE 500
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4577
Country	:	US
Telephone Number	:	843-697-0396
Fax Number	:	803-675-0787

Provider Business Practice Location Address
First Line	:	1233 BEN SAWYER BLVD
Second Line	:	SUITE 500
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4577
Country	:	US
Telephone Number	:	843-697-0396
Fax Number	:	803-675-0787

Authorized Official
Title or Position	:	OWNER, SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. JENNIFER ALLISON REIDENBACH
Credential	:	MSR, CCC-SLP
Telephone Number	:	843-697-0396

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/31/2008

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Directions to “ALLISON THERAPEUTICS, LLC ” Practice Location

Language	Start Address	Practice Location

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