Soraya Allen
Individual provider Active NPI Counselor · Peoria, IL
NPI 1295589158 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1295589158
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 178.018376 (IL)
- Practice address
- 2610 W Richwoods Blvd
Peoria, IL 61604-7112 - Phone
- (309) 323-6600
- NPI assigned
- Apr 16, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.018376 | IL | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 178.018376 | IL | Yes |
Addresses
Primary practice location
2610 W Richwoods Blvd
Peoria, IL 61604-7112
Mailing address
5400 W Landens Way Apt 6B
Peoria, IL 61615-9226
Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.