Provider Demographics
NPI:1821738782
Name:ALLEN, TIMOTHY JORDAN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JORDAN
Last Name:ALLEN
Suffix:
Gender:M
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 1:640 S 80 E STE 110
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7090
Mailing Address - Country:US
Mailing Address - Phone:208-681-5827
Mailing Address - Fax:
Practice Address - Street 1:640 S 80 E STE 110
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-7090
Practice Address - Country:US
Practice Address - Phone:435-557-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-5337235Z00000X
UT13944820-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist