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General NPI Number Information
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NPI Number | 1952866527
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Entity Type | Individual
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Provider Name | DYLAN MICHAEL ALLEN LPC-IT, SAC-IT
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Gender | Male
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 124 N FRANKLIN ST
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1901
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Country | US
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Telephone | 414-719-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 S 86TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53228-1711
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Country | US
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Telephone | 414-719-4080
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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 | 8595-226
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License Number State | WI
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