Healthcare Provider Details

I. General information

NPI: 1285101196
Provider Name (Legal Business Name): MRS. JENNIFER ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 09/26/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 LEWIS DOWNS DR
CHRISTIANA TN
37037-5563
US

IV. Provider business mailing address

1110 LEWIS DOWNS DR
CHRISTIANA TN
37037-5563
US

V. Phone/Fax

Practice location:
  • Phone: 708-518-9300
  • Fax:
Mailing address:
  • Phone: 708-518-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024340
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: