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NPI Code Detail

MEDICARE: DR. ALLISON L FERNANDER PSYD

MEDICARE: DR. ALLISON L FERNANDER PSYD
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
1103TC0700XClinical Psychologist6658OH

General Provider Information

NPI Number : 1629379920
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALLISON L FERNANDER PSYD
Provider Business Mailing Address
First Line : 1020 WOODMAN DR
Second Line : SUITE 225
City : DAYTON
State : OH
Zip : 45432-1446
Country : US
Telephone Number : 937-254-9210
Fax Number : 937-254-9267
Provider Business Practice Location Address
First Line : 9 NORTH EDWIN C MOSES BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45402-8470
Country : US
Telephone Number : 937-775-4300
Fax Number : 937-254-9267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2010
Last Update Date : 03/30/2011

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