Provider Demographics
NPI:1124246871
Name:TIERNAN, JEAN K (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:TIERNAN
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SHINGLETON
Mailing Address - State:MI
Mailing Address - Zip Code:49884-0115
Mailing Address - Country:US
Mailing Address - Phone:847-894-4919
Mailing Address - Fax:
Practice Address - Street 1:1001 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3217
Practice Address - Country:US
Practice Address - Phone:847-524-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0176231041C0700X
101Y00000X
MI68011086061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical