Provider Demographics
NPI:1124898705
Name:BROCKWAY, ALLISON (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BROCKWAY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2305
Mailing Address - Country:US
Mailing Address - Phone:309-369-3351
Mailing Address - Fax:
Practice Address - Street 1:203 FRANCES ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2305
Practice Address - Country:US
Practice Address - Phone:309-369-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0258031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical