Provider Demographics
NPI:1447682505
Name:MEDER, ALLISON MARIE (MA,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:MARIE
Last Name:MEDER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 SUNNYSIDE AVE
Mailing Address - Street 2:2101 HAWORTH HALL
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7600
Mailing Address - Country:US
Mailing Address - Phone:785-864-4692
Mailing Address - Fax:785-864-5094
Practice Address - Street 1:1170 TIMBER RUN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4482
Practice Address - Country:US
Practice Address - Phone:314-469-0606
Practice Address - Fax:314-469-3294
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2013024723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist