Provider Demographics
NPI:1104059682
Name:ALLAN, MARYANNE MILLER (M, ED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:MILLER
Last Name:ALLAN
Suffix:
Gender:F
Credentials:M, ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7263
Mailing Address - Country:US
Mailing Address - Phone:401-847-0960
Mailing Address - Fax:401-845-9618
Practice Address - Street 1:438 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7263
Practice Address - Country:US
Practice Address - Phone:401-847-0960
Practice Address - Fax:401-845-9618
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist