=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083585699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON JOY MANKOVECKY MFT-IT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 579 DONOFRIO DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-424-9100
-----------------------------------------------------
Fax | 608-424-9099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 579 DONOFRIO DR STE 206
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719-2839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-424-9100
-----------------------------------------------------
Fax | 608-424-9099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1171-228
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------