MEDICARE: DR. JILL LYNETTE ALLEN PSY.D.

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	103TC0700X	Clinical Psychologist	071-005431	IL

General Provider Information

NPI Number	:	1649572322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL LYNETTE ALLEN PSY.D.

Provider Business Mailing Address
First Line	:	1497 SHIRE CIR
Second Line	:
City	:	INVERNESS
State	:	IL
Zip	:	60067-4772
Country	:	US
Telephone Number	:	815-444-9076
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 PYOTT RD
Second Line	:	102
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8716
Country	:	US
Telephone Number	:	815-444-9076
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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