Provider Demographics
NPI:1073642294
Name:PENNINGTON, GREGORY E (LCSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:PENNINGTON
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 1:200 HEALTHCARE DRIVE
Mailing Address - Street 2:SUITE 214 GREGORY E PENNINGTON CO WELLNESS LINK
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246
Mailing Address - Country:US
Mailing Address - Phone:618-664-2922
Mailing Address - Fax:618-664-0318
Practice Address - Street 1:200 HEALTH CARE DRIVE
Practice Address - Street 2:WELLNESS LINK GREENVILLE REGIONAL HOSPITAL
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246
Practice Address - Country:US
Practice Address - Phone:618-664-2922
Practice Address - Fax:618-664-0318
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490076511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149007651OtherMEDICAL LICENSE