Provider Demographics
NPI:1376815670
Name:SCHAFER, TABITHA KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:KATHLEEN
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GOUGAR RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-9787
Mailing Address - Country:US
Mailing Address - Phone:815-476-5405
Mailing Address - Fax:815-476-7361
Practice Address - Street 1:100 GOUGAR RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-9787
Practice Address - Country:US
Practice Address - Phone:815-476-5405
Practice Address - Fax:815-476-7361
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst