MEDICARE: JANYSE L BICE-ALLEN M.S.W., L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2375-123	WI

General Provider Information

NPI Number	:	1467401281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANYSE L BICE-ALLEN M.S.W., L.C.S.W.

Provider Business Mailing Address
First Line	:	425 S ADAMS ST
Second Line	:	SUITE 204
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4117
Country	:	US
Telephone Number	:	920-884-5005
Fax Number	:	920-884-1997

Provider Business Practice Location Address
First Line	:	425 S ADAMS ST
Second Line	:	SUITE 204
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4117
Country	:	US
Telephone Number	:	920-884-5005
Fax Number	:	920-884-1997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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