Provider Demographics
NPI:1730763541
Name:ALLAN, JONATHAN RAWLINS
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAWLINS
Last Name:ALLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9744
Mailing Address - Country:US
Mailing Address - Phone:858-242-0246
Mailing Address - Fax:
Practice Address - Street 1:239 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9744
Practice Address - Country:US
Practice Address - Phone:858-242-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician