Provider Demographics
NPI:1164941522
Name:BRASWELL, ALLISON DIANE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:DIANE
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 BLUESTEM RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7788
Mailing Address - Country:US
Mailing Address - Phone:815-978-1067
Mailing Address - Fax:779-537-4555
Practice Address - Street 1:4675 BLUESTEM RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7788
Practice Address - Country:US
Practice Address - Phone:815-978-1067
Practice Address - Fax:779-537-4555
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.018669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health