Provider Demographics
NPI:1376634394
Name:WINTRODE, ALISON (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:WINTRODE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 EAST STATE ST.
Mailing Address - Street 2:#302
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108
Mailing Address - Country:US
Mailing Address - Phone:815-399-8150
Mailing Address - Fax:815-977-5929
Practice Address - Street 1:5301 EAST STATE ST.
Practice Address - Street 2:#302
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108
Practice Address - Country:US
Practice Address - Phone:815-399-8150
Practice Address - Fax:815-977-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17077101YA0400X
IL180-004035101YP2500X
IL180004035101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional