Provider Demographics
NPI:1588246862
Name:ANDERSON, ALLISON HOPE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:HOPE
Last Name:ANDERSON
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 1:2358 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2172
Mailing Address - Country:US
Mailing Address - Phone:740-649-4125
Mailing Address - Fax:
Practice Address - Street 1:919 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3804
Practice Address - Country:US
Practice Address - Phone:937-878-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBACB664277106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBACB664277OtherREGISTERED BEHAVIOR TECHNICIAN