Provider Demographics
NPI:1417289133
Name:COPPIN, ALLYSON NAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:NAN
Last Name:COPPIN
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 1:233 E ERIE ST
Mailing Address - Street 2:SUITE 205A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2926
Mailing Address - Country:US
Mailing Address - Phone:773-609-2358
Mailing Address - Fax:
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 205A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:773-609-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490122191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical