Provider Demographics
NPI:1124739826
Name:CUMMINGS, JULIENNE A (LCSW, RN)
Entity type:Individual
Prefix:
First Name:JULIENNE
Middle Name:A
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10286
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-0286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7210 N VILLA LAKE DR STE C
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8290
Practice Address - Country:US
Practice Address - Phone:309-713-1485
Practice Address - Fax:309-419-4328
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0063651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical