Healthcare Provider Details

I. General information

NPI: 1780795948
Provider Name (Legal Business Name): KATHLEEN LOUISE ALLEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD
CICERO IL
60804-2817
US

IV. Provider business mailing address

206 N KENILWORTH AVE # NO.2
OAK PARK IL
60302-2085
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax: 708-656-6591
Mailing address:
  • Phone: 708-386-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-000772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: