Provider Demographics
NPI:1073824215
Name:NEUKOMM, NANCY SUZANNE (CADC, LCPC, NCMHC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUZANNE
Last Name:NEUKOMM
Suffix:
Gender:F
Credentials:CADC, LCPC, NCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-2811
Mailing Address - Country:US
Mailing Address - Phone:217-841-5622
Mailing Address - Fax:217-367-1058
Practice Address - Street 1:2205 E UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-2811
Practice Address - Country:US
Practice Address - Phone:217-841-5622
Practice Address - Fax:217-367-1058
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL27164101YA0400X
IL180.007459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)