Provider Demographics
NPI:1679899926
Name:DRENNEN, BETH A (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:DRENNEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1463 S BELL SCHOOL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1406
Mailing Address - Country:US
Mailing Address - Phone:815-997-3834
Mailing Address - Fax:
Practice Address - Street 1:1463 S BELL SCHOOL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1406
Practice Address - Country:US
Practice Address - Phone:815-997-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0139581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical