Provider Demographics
NPI:1730293218
Name:FOURNIER, NORMA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
Last Name:FOURNIER
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 1:201 W SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4834
Mailing Address - Country:US
Mailing Address - Phone:217-398-8888
Mailing Address - Fax:217-398-8887
Practice Address - Street 1:201 W SPRINGFIELD AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4834
Practice Address - Country:US
Practice Address - Phone:217-398-8888
Practice Address - Fax:217-398-8887
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31040415OtherBLUE CROSS BLUE SHIELD