Provider Demographics
NPI:1700182466
Name:WATSON, JOLENE F (LCSW)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:F
Last Name:WATSON
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 1:1900 E MAIN ST
Mailing Address - Street 2:SWS/122
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5100
Mailing Address - Country:US
Mailing Address - Phone:217-554-3672
Mailing Address - Fax:217-554-4815
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:SWS/122
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-3672
Practice Address - Fax:217-554-4815
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490152491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical