Provider Demographics
NPI:1750529988
Name:ALLEN, LARRY L (MSW/LISW)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MSW/LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 HIDDEN VALLEY TRL NE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9551
Mailing Address - Country:US
Mailing Address - Phone:319-622-3231
Mailing Address - Fax:319-622-3077
Practice Address - Street 1:505 39TH AVE
Practice Address - Street 2:
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-8229
Practice Address - Country:US
Practice Address - Phone:319-622-3231
Practice Address - Fax:319-622-3077
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA018441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01844OtherIOWA LICENSE