Provider Demographics
NPI:1538825476
Name:ALLEN, KAREN ELIZABETH (CMA)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA
Mailing Address - Street 1:917 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4875
Mailing Address - Country:US
Mailing Address - Phone:740-777-0074
Mailing Address - Fax:
Practice Address - Street 1:4300 CLIME RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6491
Practice Address - Country:US
Practice Address - Phone:614-363-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OH000000000207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty