Provider Demographics
NPI:1134542566
Name:DENNISON, PATIENCE (LCSW)
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:DENNISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CRAWFORD AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4954
Mailing Address - Country:US
Mailing Address - Phone:312-402-1254
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE STE 115
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4954
Practice Address - Country:US
Practice Address - Phone:312-402-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490114861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical