Provider Demographics
NPI:1528474939
Name:KALLSTROM, ALLISON PAIGE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:PAIGE
Last Name:KALLSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 DUBAY DR
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-9367
Mailing Address - Country:US
Mailing Address - Phone:715-302-0609
Mailing Address - Fax:
Practice Address - Street 1:1105 DAVIDSON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6606
Practice Address - Country:US
Practice Address - Phone:262-784-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3985-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist