Provider Demographics
NPI:1154339349
Name:TENNILL, WILLIAM R (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:TENNILL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CARPENTER ST
Mailing Address - Street 2:PO BOX 1977
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5324
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6021
Practice Address - Street 1:557 N WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1156
Practice Address - Country:US
Practice Address - Phone:217-245-7275
Practice Address - Fax:217-245-7427
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100775OtherHEALTH ALLIANCE
IL681484OtherHEALTHLINK
IL06932018OtherBC/BS
IL100775OtherHEALTH ALLIANCE
ILS14899Medicare UPIN
IL06932018OtherBC/BS