Provider Demographics
NPI:1992055016
Name:LENTZ, ALISON (SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:LENTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW ANKENY RD.
Mailing Address - Street 2:ON WITH LIFE
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023
Mailing Address - Country:US
Mailing Address - Phone:515-289-9645
Mailing Address - Fax:515-289-9649
Practice Address - Street 1:715 SW ANKENY RD.
Practice Address - Street 2:ON WITH LIFE
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-289-9645
Practice Address - Fax:515-289-9649
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist