Provider Demographics
NPI:1194275743
Name:ALLOR, BREANNA LEIGH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:ALLOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 52ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-5836
Mailing Address - Country:US
Mailing Address - Phone:616-288-8881
Mailing Address - Fax:
Practice Address - Street 1:617 52ND ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548-5836
Practice Address - Country:US
Practice Address - Phone:616-288-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25035235Z00000X
AZSLP10369235Z00000X
MI7101000729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist