Healthcare Provider Details

I. General information

NPI: 1831632256
Provider Name (Legal Business Name): NICOLE ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35W461 COUNTRY SCHOOL RD
DUNDEE IL
60118-9522
US

IV. Provider business mailing address

35W461 COUNTRY SCHOOL RD
DUNDEE IL
60118-9522
US

V. Phone/Fax

Practice location:
  • Phone: 224-231-8105
  • Fax: 224-231-8105
Mailing address:
  • Phone: 224-231-8105
  • Fax: 224-231-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017120
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: