Provider Demographics
NPI:1487134979
Name:HUMMEL, ALEXANDRIA JOANN
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:JOANN
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:JOANN
Other - Last Name:CONANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:451 COVENTRY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7569
Mailing Address - Country:US
Mailing Address - Phone:224-650-7167
Mailing Address - Fax:
Practice Address - Street 1:451 COVENTRY LN STE 101
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7569
Practice Address - Country:US
Practice Address - Phone:224-650-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL1490242571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program