Provider Demographics
NPI:1669952214
Name:TENNYSON, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S MICHIGAN AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4416
Mailing Address - Country:US
Mailing Address - Phone:888-660-4425
Mailing Address - Fax:708-843-0401
Practice Address - Street 1:150 WEILAND RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-7047
Practice Address - Country:US
Practice Address - Phone:847-465-0200
Practice Address - Fax:847-556-1278
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.018696104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker