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General NPI Number Information
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NPI Number | 1104533355
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Entity Type | Individual
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Provider Name | JENNIFER ALLEN
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Gender | Female
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 175 OLDE HALF DAY RD STE 140-9
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3062
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Country | US
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Telephone | 847-790-4959
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Fax |
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Provider Business Mailing Address
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Address Line | 60 W TERRA COTTA AVE SUITE B #243
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178009821
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License Number State | IL
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