Provider Demographics
NPI:1598857617
Name:SUDAK-ALLISON, JILL (LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SUDAK-ALLISON
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SE DELAWARE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9307
Mailing Address - Country:US
Mailing Address - Phone:515-669-4718
Mailing Address - Fax:
Practice Address - Street 1:4525 ZILKER DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-0923
Practice Address - Country:US
Practice Address - Phone:515-669-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00068106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist