Individual
MARY ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
113 E MAIN ST, STOUGHTON, WI 53589-1720
(608) 449-7201
Mailing address
113 E MAIN ST, STOUGHTON, WI 53589-1720
(608) 449-7201
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
8198-123
WI
1041C0700X
Clinical Social Worker
Primary
LCS29109
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16-59500882
—
WI
01
—
HE611A
MEDICARE PART B PROVIDER PTAN
CA
01
—
LCS29109
BOARD OF BEHAVIORAL SCIENCE
CA
01
—
LCSW 8198-123
STATE OF WISC-DEPT OF SAFETY & PROFESSIONAL SERVICES
WI
Enumeration date
07/09/2009
Last updated
04/09/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us