Provider Demographics
NPI:1497841886
Name:ALLEN, JANELLE W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 S SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5140
Mailing Address - Country:US
Mailing Address - Phone:608-238-3159
Mailing Address - Fax:608-238-3159
Practice Address - Street 1:301 TROY DR
Practice Address - Street 2:MJTC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1521
Practice Address - Country:US
Practice Address - Phone:608-301-1222
Practice Address - Fax:608-301-1436
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1931-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 10290OtherCALIFORNIA LICENSE
WI39138000Medicaid
WI50448OtherNATIONAL REGISTER
WI1931-057OtherWISCONSIN LICENSE