Provider Demographics
NPI:1811026750
Name:CROWELL, DENNIS JAY (MSW, LCSW, ACSW, DCS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAY
Last Name:CROWELL
Suffix:
Gender:M
Credentials:MSW, LCSW, ACSW, DCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4470
Mailing Address - Country:US
Mailing Address - Phone:309-642-9409
Mailing Address - Fax:
Practice Address - Street 1:15 S CAPITOL ST
Practice Address - Street 2:SUITE 213
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4100
Practice Address - Country:US
Practice Address - Phone:309-642-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical