Provider Demographics
NPI:1649572322
Name:ALLEN, JILL LYNETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:LYNETTE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 SHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4772
Mailing Address - Country:US
Mailing Address - Phone:815-444-9076
Mailing Address - Fax:
Practice Address - Street 1:900 PYOTT RD
Practice Address - Street 2:102
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8716
Practice Address - Country:US
Practice Address - Phone:815-444-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical