Provider Demographics
NPI:1407463706
Name:KEMBLE, ALLISON NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICHOLE
Last Name:KEMBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 SHAWN CT
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-4320
Mailing Address - Country:US
Mailing Address - Phone:573-239-3321
Mailing Address - Fax:
Practice Address - Street 1:806 SHAWN CT
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-4320
Practice Address - Country:US
Practice Address - Phone:573-239-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200012431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical