Provider Demographics
NPI:1427304062
Name:DENSON, KENNETH RAY (LSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:DENSON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 KATELAND WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3720
Mailing Address - Country:US
Mailing Address - Phone:630-726-0729
Mailing Address - Fax:
Practice Address - Street 1:686 KATELAND WAY
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3720
Practice Address - Country:US
Practice Address - Phone:630-726-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.011247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker