Provider Demographics
NPI:1962051151
Name:ALO, SHAIRENE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHAIRENE
Middle Name:
Last Name:ALO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-8609
Mailing Address - Country:US
Mailing Address - Phone:419-304-0806
Mailing Address - Fax:
Practice Address - Street 1:6400 MONROE ST STE C
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1400
Practice Address - Country:US
Practice Address - Phone:419-540-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-12451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist