Provider Demographics
NPI:1780795948
Name:ALLEN, KATHLEEN LOUISE (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N KENILWORTH AVE # NO.2
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2085
Mailing Address - Country:US
Mailing Address - Phone:708-386-1718
Mailing Address - Fax:
Practice Address - Street 1:5341 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2817
Practice Address - Country:US
Practice Address - Phone:708-656-6430
Practice Address - Fax:708-656-6591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202591OtherMEDICARE
IL1617631OtherBLUE CROSS BLUE SHIELD
IL180000772Medicaid