Provider Demographics
NPI:1083040315
Name:COLLAZO, ALLISON G (LMSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:G
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3602
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-660-7510
Practice Address - Street 1:402 E 2ND ST
Practice Address - Street 2:STE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2504
Practice Address - Country:US
Practice Address - Phone:316-660-7800
Practice Address - Fax:316-941-5060
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8489104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker