MEDICARE: SUE A VANALLEN

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	103T00000X	Psychologist	2598	OH

General Provider Information

NPI Number	:	1295954295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE A VANALLEN

Provider Business Mailing Address
First Line	:	513 WINDSOR PARK DR.
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458
Country	:	US
Telephone Number	:	937-435-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 WINDSOR PARK DR.
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459
Country	:	US
Telephone Number	:	937-435-4519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	04/05/2026

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Directions to “ SUE A VANALLEN ” Practice Location

Language	Start Address	Practice Location

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