Basic Information
| Provider Information | |||||||||
| NPI: | 1982245924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEUBER | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19110 MONTGOMERY VILLAGE AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY VILLAGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208863706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019776317 | ||||||||
| FaxNumber: | 3019778503 | ||||||||
| Practice Location | |||||||||
| Address1: | 5530 WISCONSIN AVE STE 1540 | ||||||||
| Address2: | |||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208154321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019070002 | ||||||||
| FaxNumber: | 3019077709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2019 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 1503 | MD | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 301325000 | 05 | MD | MEDICAID |