Provider Demographics
NPI:1861005290
Name:BODINE, ALLISON GRACE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GRACE
Last Name:BODINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 LAKE SUPERIOR RD APT 204
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6253
Mailing Address - Country:US
Mailing Address - Phone:267-875-5155
Mailing Address - Fax:
Practice Address - Street 1:2004 VALPARAISO ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3138
Practice Address - Country:US
Practice Address - Phone:219-477-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty