Individual
MRS. JACQUELYN LAVETTE ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L, CPAM
Contact information
Practice address
17366 WAUSAU AVE, SOUTH HOLLAND, IL 60473-3359
(708) 705-2670
Mailing address
17366 WAUSAU AVE, SOUTH HOLLAND, IL 60473-3359
(708) 705-2670
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
056007568
IL
Other
Enumeration date
02/11/2010
Last updated
02/11/2010
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