Provider Demographics
NPI:1992258990
Name:LEWELLEN, CATHERINE (MSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LEWELLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARION ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2838
Mailing Address - Country:US
Mailing Address - Phone:309-370-8836
Mailing Address - Fax:
Practice Address - Street 1:7820 N UNIVERSITY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1220
Practice Address - Country:US
Practice Address - Phone:309-689-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health