Active NPI
Connie Nichole Lundgren
- Professional Counselor
- Bloomington, IL
National Provider Identifier
1427930486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.021777
- Practice address
- 1709 Jumer Dr Ste a
Bloomington, IL 61704-0914 - Phone
- (309) 463-5800
- Fax
- (833) 914-2704
- NPI assigned
- Jul 22, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.021777 | IL | Primary |
Addresses
Primary practice location
1709 Jumer Dr Ste a
Bloomington, IL 61704-0914
Mailing address
307 N Pearl St
Le Roy, IL 61752-1560
Phone (217) 521-2671
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.021777 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753142400000",
"number": "1427930486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 N PEARL ST",
"city": "LE ROY",
"state": "IL",
"postal_code": "617521560",
"telephone_number": "217-521-2671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1709 JUMER DR STE A",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617040914",
"telephone_number": "309-463-5800",
"fax_number": "833-914-2704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDGREN",
"first_name": "CONNIE",
"middle_name": "NICHOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-07-22",
"last_updated": "2025-07-22",
"certification_date": "2025-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.021777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.