Provider Demographics
NPI:1003040197
Name:ALLEN, KIMBERLY JO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JO
Last Name:ALLEN
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 1:509 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1573
Mailing Address - Country:US
Mailing Address - Phone:563-343-9655
Mailing Address - Fax:
Practice Address - Street 1:4703 44TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7189
Practice Address - Country:US
Practice Address - Phone:309-788-9581
Practice Address - Fax:309-788-9608
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0135791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical