Healthcare Provider Details

I. General information

NPI: 1013873546
Provider Name (Legal Business Name): IMANI ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 GILBOA AVE
ZION IL
60099-1618
US

IV. Provider business mailing address

1713 GILBOA AVE
ZION IL
60099-1618
US

V. Phone/Fax

Practice location:
  • Phone: 224-788-0188
  • Fax: 224-538-3303
Mailing address:
  • Phone: 224-788-0188
  • Fax: 224-538-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022111
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: