Provider Demographics
NPI:1477650604
Name:ALLAN, CAROL M (MSW, LCSW, DCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:ALLAN
Suffix:
Gender:F
Credentials:MSW, LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N BROOKFIELD RD STE 103
Mailing Address - Street 2:SUBURBAN COUNSELING SERVICES
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5858
Mailing Address - Country:US
Mailing Address - Phone:262-391-4892
Mailing Address - Fax:262-789-8759
Practice Address - Street 1:675 N BROOKFIELD RD STE 103
Practice Address - Street 2:SUBURBAN COUNSELING SERVICES
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5858
Practice Address - Country:US
Practice Address - Phone:262-391-4892
Practice Address - Fax:262-789-8759
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9631231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000044386OtherMEDICARE PROVIDER ID#: