Provider Demographics
NPI:1437291705
Name:ALLEMAGNE, KEVIN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:ALLEMAGNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 MARKETPLACE DRIVE
Mailing Address - Street 2:SUITE # 212
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5327
Mailing Address - Country:US
Mailing Address - Phone:608-325-9500
Mailing Address - Fax:888-345-6310
Practice Address - Street 1:2916 MARKETPLACE DRIVE
Practice Address - Street 2:SUITE # 212
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5327
Practice Address - Country:US
Practice Address - Phone:608-325-9500
Practice Address - Fax:888-345-6310
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist