Provider Demographics
NPI:1063617249
Name:ISRAEL, ALLEN H (MS)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:H
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 SW 31ST AVE
Mailing Address - Street 2:#213
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6920
Mailing Address - Country:US
Mailing Address - Phone:954-966-4411
Mailing Address - Fax:
Practice Address - Street 1:5201 SW 31ST AVE
Practice Address - Street 2:#213
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6920
Practice Address - Country:US
Practice Address - Phone:954-966-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist