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General NPI Number Information
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NPI Number | 1336379304
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Entity Type | Organization
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Legal Business Name | JOHN WILLIAM ALLEN, PSY.D. P.C.
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 4055 W PETERSON AVE STE. 201
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City | CHICAGO
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State | IL
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Zip | 60646-6182
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Country | US
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Telephone | 773-478-2982
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Fax | 773-478-8105
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Provider Business Mailing Address
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Address Line | 4055 W PETERSON AVE STE. 201
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City | CHICAGO
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State | IL
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Zip | 60646-6182
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Country | US
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Telephone | 773-478-2982
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Fax | 773-478-8105
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JOHN WILLIAM ALLEN
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Credential | PSY.D.
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Telephone | 773-478-2982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 071-007404
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 071-007404
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License Number State | IL
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