Provider Demographics
NPI:1558557942
Name:WISTE WEBB, ALLISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WISTE WEBB
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:PO BOX 162
Mailing Address - Street 2:1510 W OTTAWA RD
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-0162
Mailing Address - Country:US
Mailing Address - Phone:217-379-4302
Mailing Address - Fax:217-379-4304
Practice Address - Street 1:1510 W OTTAWA RD
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-4090
Practice Address - Country:US
Practice Address - Phone:217-379-4302
Practice Address - Fax:217-379-4304
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149016652Medicare PIN