Provider Demographics
NPI:1578300901
Name:WOODFORD, ALLISON STAKER (AUD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:STAKER
Last Name:WOODFORD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11450 TENISON LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1461
Mailing Address - Country:US
Mailing Address - Phone:214-240-1478
Mailing Address - Fax:
Practice Address - Street 1:2895 FACILITIES WAY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-0034
Practice Address - Country:US
Practice Address - Phone:972-883-3630
Practice Address - Fax:972-883-3622
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81584231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist