Provider Demographics
NPI:1225525314
Name:TEBBE, DONNA M (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:TEBBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14487 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-5124
Mailing Address - Country:US
Mailing Address - Phone:618-654-8686
Mailing Address - Fax:
Practice Address - Street 1:13317 COUNTY HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:VENEDY
Practice Address - State:IL
Practice Address - Zip Code:62214-1103
Practice Address - Country:US
Practice Address - Phone:618-317-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0111881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical