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General NPI Number Information
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NPI Number | 1114816626
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Entity Type | Individual
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Provider Name | JEREMY ALLEN SSP, NCSP
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 3118 N OLCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60707-1134
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Country | US
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Telephone | 312-796-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 W VAN BUREN ST UNIT 1720
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City | CHICAGO
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State | IL
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Zip | 60607-3263
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Country | US
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Telephone | 504-458-5756
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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