Provider Demographics
NPI:1407997208
Name:HUMMEL, EMILY K (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:K
Other - Last Name:KRASEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1405
Mailing Address - Country:US
Mailing Address - Phone:815-751-3479
Mailing Address - Fax:
Practice Address - Street 1:721 CROATIAN CT
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2494
Practice Address - Country:US
Practice Address - Phone:815-751-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN