Healthcare Provider Details

I. General information

NPI: 1508365917
Provider Name (Legal Business Name): JENNIFER JOAN ALLEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 MILLER RD NE
RIO RANCHO NM
87144-7771
US

IV. Provider business mailing address

PO BOX 252
SWIFTWATER PA
18370-0252
US

V. Phone/Fax

Practice location:
  • Phone: 570-664-0441
  • Fax: 505-230-4851
Mailing address:
  • Phone: 570-350-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010248
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: