Provider Demographics
NPI:1144971359
Name:FERGUSON, ALLISON MARIE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1542
Mailing Address - Country:US
Mailing Address - Phone:502-409-1007
Mailing Address - Fax:
Practice Address - Street 1:1630 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1542
Practice Address - Country:US
Practice Address - Phone:502-409-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist