Provider Demographics
NPI:1720634553
Name:ALLEN, JILL E (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
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 1:8787 CORNTHWAITE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:IL
Mailing Address - Zip Code:62544-7024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 PONDELLA RD STE 9
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4340
Practice Address - Country:US
Practice Address - Phone:239-652-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490192371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical