Provider Demographics
NPI:1740857820
Name:PLUMMER, REGINA (LCSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:GRIBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-7518
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:220 E COUNTY RD
Practice Address - Street 2:E ANNEX BLDG
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-3125
Practice Address - Country:US
Practice Address - Phone:618-498-8467
Practice Address - Fax:618-639-2017
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL149.0241371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor