Provider Demographics
NPI:1003564345
Name:ALLEN, VANESSA (CSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9090 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8313
Mailing Address - Country:US
Mailing Address - Phone:502-439-1050
Mailing Address - Fax:
Practice Address - Street 1:10300 BROOKRIDGE VILLAGE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4474
Practice Address - Country:US
Practice Address - Phone:502-785-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7276104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker