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General NPI Number Information
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NPI Number | 1073642294
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Entity Type | Individual
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Provider Name | GREGORY E PENNINGTON LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 200 HEALTH CARE DRIVE WELLNESS LINK GREENVILLE REGIONAL HOSPITAL
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City | GREENVILLE
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State | IL
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Zip | 62246
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Country | US
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Telephone | 618-664-2922
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Fax | 618-664-0318
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Provider Business Mailing Address
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Address Line | 200 HEALTHCARE DRIVE SUITE 214 GREGORY E PENNINGTON CO WELLNESS LINK
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City | GREENVILLE
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State | IL
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Zip | 62246
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Country | US
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Telephone | 618-664-2922
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Fax | 618-664-0318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149007651
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License Number State | IL
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