=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427456037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLISON J. LIST, LCSW, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2014
-----------------------------------------------------
Last Update Date | 12/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1219 CAROLINE CT
-----------------------------------------------------
City | VERNON HILLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60061-4192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-217-2435
-----------------------------------------------------
Fax | 847-520-4157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1219 CAROLINE CT
-----------------------------------------------------
City | VERNON HILLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60061-4192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-217-2435
-----------------------------------------------------
Fax | 847-520-4157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. ALLISON J. LIST
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 224-217-2435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 060011386
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------