Provider Demographics
NPI:1366621179
Name:EASLEY, ALLISON DENISE (CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:DENISE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 E FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-2014
Mailing Address - Country:US
Mailing Address - Phone:618-201-0356
Mailing Address - Fax:
Practice Address - Street 1:4221 SHAW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3526
Practice Address - Country:US
Practice Address - Phone:314-772-0994
Practice Address - Fax:314-865-3759
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007032047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007032047Medicaid