Provider Demographics
NPI:1861748212
Name:CLINGENPEEL, ALISON PAIGE (MA)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:PAIGE
Last Name:CLINGENPEEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6502
Mailing Address - Country:US
Mailing Address - Phone:260-493-0055
Mailing Address - Fax:260-493-2051
Practice Address - Street 1:7407 TURKEY RUN DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7774
Practice Address - Country:US
Practice Address - Phone:260-493-0055
Practice Address - Fax:260-493-2051
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002379A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health