Individual
MRS. JACQUELINE MICHELLE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCCSLP
Contact information
Practice address
110 CAMPUS DRIVE, BRADFORD, PA 16701
(814) 887-5591
(814) 887-5666
Mailing address
PO BOX 83, DISTANT, PA 16223
(814) 541-1073
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL00474DL
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001938638000Z
—
PA
Enumeration date
04/16/2007
Last updated
07/08/2007
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