MEDICARE: MS. BELINDA ALLEN

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	104100000X	Social Worker		IL

General Provider Information

NPI Number	:	1720297187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BELINDA ALLEN

Provider Business Mailing Address
First Line	:	2924 S 9TH AVE
Second Line	:
City	:	BROADVIEW
State	:	IL
Zip	:	60155-4826
Country	:	US
Telephone Number	:	708-343-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1969 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3765
Country	:	US
Telephone Number	:	773-826-9626
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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