Samantha Louise Allen, MSW, LCSW

Individual provider Active NPI Clinical Social Worker · Evergreen Park, IL

NPI 1306385398 · NPPES record last updated Jul 20, 2018

Key facts

NPI
1306385398
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
149019762 (IL)
Practice address
9730 S Western Ave
Evergreen Park, IL 60805
Phone
(773) 242-9726
NPI assigned
Feb 23, 2017
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
149019762ILMDClinical Social Worker
150015404ILMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 150015404 IL
Clinical Social Worker 1041C0700X 149019762 IL Yes

Addresses

Primary practice location

9730 S Western Ave
Evergreen Park, IL 60805

Mailing address

9730 S Western Ave
Evergreen Park, IL 60805-2814
Phone (773) 242-9726

Other practice location 1

12544 S Lincoln St
Calumet Park, IL 60827-5627
Phone (773) 892-9068

Other providers in Evergreen Park, IL

All providers in Evergreen Park, IL · Clinical Social Worker in Illinois

Sources for this page

Verify at the official NPI Registry.