Provider Demographics
NPI:1538631288
Name:COLTISOR, ALLISON (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:COLTISOR
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2340 TEASTER LANE UNIT 111
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6244
Mailing Address - Country:US
Mailing Address - Phone:865-366-1408
Mailing Address - Fax:
Practice Address - Street 1:2340 TEASTER LANE UNIT 111
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6244
Practice Address - Country:US
Practice Address - Phone:865-366-1408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1922231H00000X
CAAU3313231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist