Provider Demographics
NPI:1427456037
Name:ALLISON J. LIST, LCSW, PC
Entity type:Organization
Organization Name:ALLISON J. LIST, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-217-2435
Mailing Address - Street 1:1219 CAROLINE CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4192
Mailing Address - Country:US
Mailing Address - Phone:224-217-2435
Mailing Address - Fax:847-520-4157
Practice Address - Street 1:1219 CAROLINE CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4192
Practice Address - Country:US
Practice Address - Phone:224-217-2435
Practice Address - Fax:847-520-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060011386251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health