Provider Demographics
NPI:1386834075
Name:MUNDY-HEMMERICH, ELIZABETH (MSW, LCSW, QMHP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MUNDY-HEMMERICH
Suffix:
Gender:F
Credentials:MSW, LCSW, QMHP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4100 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8350
Mailing Address - Country:US
Mailing Address - Phone:815-385-6400
Mailing Address - Fax:
Practice Address - Street 1:2108 63RD ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4454
Practice Address - Country:US
Practice Address - Phone:262-652-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL149.0139001041C0700X
WI9207-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor