Provider Demographics
NPI:1730504317
Name:FENNER, ALLISON (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:FENNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MASTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1700
Mailing Address - Country:US
Mailing Address - Phone:614-367-2380
Mailing Address - Fax:
Practice Address - Street 1:760 ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1700
Practice Address - Country:US
Practice Address - Phone:614-367-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist