Healthcare Provider Details

I. General information

NPI: 1245027580
Provider Name (Legal Business Name): ALLISON AHLGRIM LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W NEVADA ST
URBANA IL
61801-3789
US

IV. Provider business mailing address

1837 W PATTERSON AVE APT 309
CHICAGO IL
60613-3549
US

V. Phone/Fax

Practice location:
  • Phone: 217-333-2261
  • Fax:
Mailing address:
  • Phone: 309-660-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: