Provider Demographics
NPI:1578564951
Name:ALLEN, JEFFERY B (PHD, ABPP-ABCN)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:B
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD, ABPP-ABCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 W BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6069
Mailing Address - Country:US
Mailing Address - Phone:765-457-4800
Mailing Address - Fax:
Practice Address - Street 1:2354 W BOULEVARD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6069
Practice Address - Country:US
Practice Address - Phone:765-457-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043837A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216328Medicaid
S57971Medicare UPIN
OH2216328Medicaid