Provider Demographics
NPI:1003102401
Name:LEDBETTER, TABITHA (LCSW)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:LEDBETTER
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 1:355 RIDGE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3328
Mailing Address - Country:US
Mailing Address - Phone:773-517-2444
Mailing Address - Fax:
Practice Address - Street 1:355 RIDGE AVE FL 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3328
Practice Address - Country:US
Practice Address - Phone:847-316-6262
Practice Address - Fax:847-316-2214
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0147021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-014702OtherLCSW