Provider Demographics
NPI:1649315656
Name:PRENZLER, THERESA O (LCSW)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:O
Last Name:PRENZLER
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 1:712 E EMPIRE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3252
Mailing Address - Country:US
Mailing Address - Phone:309-824-5180
Mailing Address - Fax:309-828-8084
Practice Address - Street 1:712 E EMPIRE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3252
Practice Address - Country:US
Practice Address - Phone:309-824-5180
Practice Address - Fax:309-828-8084
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05732094OtherBCBS OF IL