Provider Demographics
NPI:1164994562
Name:WOLLERT, ALLISON FAYE (LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:FAYE
Last Name:WOLLERT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1450
Mailing Address - Country:US
Mailing Address - Phone:224-239-0099
Mailing Address - Fax:
Practice Address - Street 1:1641 N MILWAUKEE AVE STE 7
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:847-362-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-23
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health