Provider Demographics
NPI:1013069228
Name:ALLEN, ALLISON (PHD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-9530
Mailing Address - Country:US
Mailing Address - Phone:715-373-0380
Mailing Address - Fax:715-373-0381
Practice Address - Street 1:809 W PINE ST
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-9530
Practice Address - Country:US
Practice Address - Phone:715-373-0380
Practice Address - Fax:715-373-0381
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2376-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40906400Medicaid
WIP58487Medicare UPIN