Provider Demographics
NPI:1104551217
Name:ALLEN, IRMALENNA GORDON
Entity type:Individual
Prefix:
First Name:IRMALENNA
Middle Name:GORDON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-5503
Mailing Address - Country:US
Mailing Address - Phone:865-406-1525
Mailing Address - Fax:
Practice Address - Street 1:118 MABRY HOOD RD STE 400
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2219
Practice Address - Country:US
Practice Address - Phone:865-982-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical