Provider Demographics
NPI:1720797970
Name:GREENE, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GREENE
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 1:1001 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5653
Mailing Address - Country:US
Mailing Address - Phone:248-930-9959
Mailing Address - Fax:
Practice Address - Street 1:3096 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1302
Practice Address - Country:US
Practice Address - Phone:248-556-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI373H00000X
251C00000X, 385H00000X, 390200000X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program