Provider Demographics
NPI:1518068220
Name:ALLEN, JANE C (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11477 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7130
Mailing Address - Country:US
Mailing Address - Phone:314-567-5000
Mailing Address - Fax:314-567-3110
Practice Address - Street 1:11477 OLDE CABIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7130
Practice Address - Country:US
Practice Address - Phone:314-567-5000
Practice Address - Fax:314-567-3110
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR0027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16555OtherBLUE CROSS BLUE SHIELD
MO6109135OtherUNITED HEALTHCARE
MO117559OtherHEALTHLINK
MO680004947OtherRR MEDICARE
MO000070018Medicare ID - Type Unspecified