Provider Demographics
NPI:1912627233
Name:ALLEN, MICHELYVE PETIT
Entity type:Individual
Prefix:
First Name:MICHELYVE
Middle Name:PETIT
Last Name:ALLEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 PARKLAWN DRIVE
Mailing Address - Street 2:SUITE 200, PMB 1050
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:215-275-3687
Mailing Address - Fax:
Practice Address - Street 1:3709 S GEORGE MASON DR APT T14E
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-4749
Practice Address - Country:US
Practice Address - Phone:215-275-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist