Provider Demographics
NPI:1245766773
Name:HENNELLY, JOYCE ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ANN
Last Name:HENNELLY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 DI PAOLO CTR
Mailing Address - Street 2:SUITE J
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5212
Mailing Address - Country:US
Mailing Address - Phone:312-209-3927
Mailing Address - Fax:
Practice Address - Street 1:4350 DI PAOLO CTR
Practice Address - Street 2:SUITE J
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5212
Practice Address - Country:US
Practice Address - Phone:312-209-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0162841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical