Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149.013579 | IL |
NPI | 1003040197 |
---|---|
Provider Name | Mrs. Kimberly Jo Allen |
First Address | Eldridge, IA 52748-1573 |
Second Address | Rock Island, IL 61201-7189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 05/05/2009 |