Healthcare Provider Details

I. General information

NPI: 1578564951
Provider Name (Legal Business Name): JEFFERY B ALLEN PHD, ABPP-ABCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/30/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 W BOULEVARD
KOKOMO IN
46902-6069
US

IV. Provider business mailing address

2354 W BOULEVARD
KOKOMO IN
46902-6069
US

V. Phone/Fax

Practice location:
  • Phone: 765-457-4800
  • Fax:
Mailing address:
  • Phone: 765-457-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20043837A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: