Healthcare Provider Details

I. General information

NPI: 1750529988
Provider Name (Legal Business Name): LARRY L ALLEN M.S.W./L.I.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 39TH AVE
AMANA IA
52203-8229
US

IV. Provider business mailing address

2752 HIDDEN VALLEY TRL NE
SOLON IA
52333-9551
US

V. Phone/Fax

Practice location:
  • Phone: 319-622-3231
  • Fax: 319-622-3077
Mailing address:
  • Phone: 319-622-3231
  • Fax: 319-622-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01844
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: