MEDICARE: JANIS ANNE ALLEN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2283	MN

General Provider Information

NPI Number	:	1215236302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS ANNE ALLEN LICSW

Provider Business Mailing Address
First Line	:	214 CHANDLER AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1675
Country	:	US
Telephone Number	:	218-471-4327
Fax Number	:	218-744-9632

Provider Business Practice Location Address
First Line	:	214 CHANDLER AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1675
Country	:	US
Telephone Number	:	218-471-4327
Fax Number	:	218-744-9632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	12/04/2014

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Directions to “ JANIS ANNE ALLEN LICSW” Practice Location

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