Basic Information
| Provider Information | |||||||||
| NPI: | 1841224185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEISNER | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 557 N WESTGATE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626501156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172457275 | ||||||||
| FaxNumber: | 2172457427 | ||||||||
| Practice Location | |||||||||
| Address1: | 557 N WESTGATE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626501156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172457275 | ||||||||
| FaxNumber: | 2172457427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 036-073607 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 036112696 | 05 | IL | MEDICAID | 036112696 | 01 | IL | STATE LICENSE | OTHER | CB3741 | 01 | IL | RR MEDICARE GROUP# | OTHER | 06932018 | 01 | IL | BC/BS | OTHER | 681484 | 01 | IL | HEALTHLINK | OTHER | P00200974 | 01 | IL | RR MEDICARE PIN | OTHER | 100840 | 01 | IL | HEALTH ALLIANCE | OTHER | 370661230 | 01 | IL | IRS TAX ID | OTHER |