Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2376-057 | WI |
Y | 103TC0700X | Clinical Psychologist | 2376-057 | WI |
NPI | 1013069228 |
---|---|
Provider Name | Allison Allen |
First Address | Washburn, WI 54891-9530 |
Second Address | Washburn, WI 54891-9530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40906400 | (05) | WI |
P58487 | (02) | WI |