Provider Demographics
NPI:1952993404
Name:HUMMEL, KRISTINE (LCSW CADC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3025
Mailing Address - Country:US
Mailing Address - Phone:630-542-1769
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3025
Practice Address - Country:US
Practice Address - Phone:630-542-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL1490069141041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool