MEDICARE: MS. STEPHANIE KIM ALLEN MSW, LICSW, GMHS

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	LW60417321	WA
2	1041C0700X	Clinical Social Worker	103685	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01627692	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235434507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE KIM ALLEN MSW, LICSW, GMHS

Provider Business Mailing Address
First Line	:	PO BOX 4113
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79608
Country	:	US
Telephone Number	:	325-725-0162
Fax Number	:	855-270-4606

Provider Business Practice Location Address
First Line	:	3301 N 3RD ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79603-7054
Country	:	US
Telephone Number	:	325-725-0162
Fax Number	:	855-270-4606

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	04/20/2021

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