Provider Demographics
NPI:1992936819
Name:SMITH FANCHER, ALLISON J (MA, CFY-SLP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:SMITH FANCHER
Suffix:
Gender:F
Credentials:MA, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-2319
Mailing Address - Country:US
Mailing Address - Phone:765-667-9893
Mailing Address - Fax:
Practice Address - Street 1:807 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-2319
Practice Address - Country:US
Practice Address - Phone:765-667-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001984A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist