Healthcare Provider Details

I. General information

NPI: 1568366268
Provider Name (Legal Business Name): CHRISTINE R CRUMINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 N SHERIDAN RD STE A
PEORIA IL
61614-5997
US

IV. Provider business mailing address

PO BOX 463
CHICAGO IL
60690-0463
US

V. Phone/Fax

Practice location:
  • Phone: 309-316-7632
  • Fax: 312-663-0504
Mailing address:
  • Phone: 312-663-1130
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150105285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: