Provider Demographics
NPI:1619207792
Name:TURNBULL, TRUDI MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRUDI
Middle Name:MARIE
Last Name:TURNBULL
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 1:2100 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-9115
Mailing Address - Country:US
Mailing Address - Phone:217-732-3771
Mailing Address - Fax:217-735-1738
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-9115
Practice Address - Country:US
Practice Address - Phone:217-732-3771
Practice Address - Fax:217-735-1738
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490045761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical