Provider Demographics
NPI:1629086913
Name:TENNILL, JULIE W (MSW, ACSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:W
Last Name:TENNILL
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W WALNUT ST
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1150
Mailing Address - Country:US
Mailing Address - Phone:217-245-7275
Mailing Address - Fax:217-245-7427
Practice Address - Street 1:1515 W WALNUT ST
Practice Address - Street 2:BUILDING 1
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1150
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:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490018751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILHEALTHLINKOther681484
IL06932018OtherBC/BS
IL41-2267080OtherIRS TAX ID
IL100842OtherHEALTH ALLIANCE
IL149001875OtherIL STATE LICENSE
IL100842OtherHEALTH ALLIANCE
IL06932018OtherBC/BS
IL149001875OtherIL STATE LICENSE