Provider Demographics
NPI:1215236302
Name:ALLEN, JANIS ANNE (LICSW)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:ANNE
Other - Last Name:LYONAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISCW
Mailing Address - Street 1:214 CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1675
Mailing Address - Country:US
Mailing Address - Phone:218-471-4327
Mailing Address - Fax:218-744-9632
Practice Address - Street 1:214 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-1675
Practice Address - Country:US
Practice Address - Phone:218-471-4327
Practice Address - Fax:218-744-9632
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical