MEDICARE: HEIDI SUE 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	7345	NE
2	101YM0800X	Mental Health Counselor	11768	NE

General Provider Information

NPI Number	:	1871128017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI SUE ALLEN

Provider Business Mailing Address
First Line	:	1240 SUNSET TERRACE RD
Second Line	:
City	:	PHILLIPS
State	:	NE
Zip	:	68865-1728
Country	:	US
Telephone Number	:	308-660-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1334
Country	:	US
Telephone Number	:	308-382-4297
Fax Number	:

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

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	06/09/2023

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