Provider Demographics
NPI:1821878430
Name:ALLEN, BRITTANY ALIEAN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ALIEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 W MONTROSE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1214
Mailing Address - Country:US
Mailing Address - Phone:312-687-0224
Mailing Address - Fax:
Practice Address - Street 1:1626 W MONTROSE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1214
Practice Address - Country:US
Practice Address - Phone:312-687-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227022962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty