Provider Demographics
NPI:1639265663
Name:DENMAN, JONATHAN CLARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CLARK
Last Name:DENMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WEISBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-2320
Mailing Address - Country:US
Mailing Address - Phone:618-969-7170
Mailing Address - Fax:
Practice Address - Street 1:119 WEISBROOK LN
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-2320
Practice Address - Country:US
Practice Address - Phone:618-969-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-13AP-PL103T00000X
IL071.117560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist