Provider Demographics
NPI:1194838623
Name:HENSON, JOHN W III (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:HENSON
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR STE 1102756
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:773-880-8820
Mailing Address - Fax:773-880-8469
Practice Address - Street 1:680 N LAKE SHORE DR STE 1102756
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:773-880-8820
Practice Address - Fax:773-880-8469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490072061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL482120Medicare ID - Type Unspecified