Provider Demographics
NPI:1013048636
Name:GIBBLE, PEGGY LIN (LCSW, CADC, MISA I)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LIN
Last Name:GIBBLE
Suffix:
Gender:F
Credentials:LCSW, CADC, MISA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3965
Mailing Address - Country:US
Mailing Address - Phone:847-732-6031
Mailing Address - Fax:
Practice Address - Street 1:888 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3965
Practice Address - Country:US
Practice Address - Phone:847-895-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490025261041C0700X
IL17392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46295Medicare UPIN
IL284930Medicare ID - Type Unspecified
IL284931Medicare ID - Type Unspecified
IL284932Medicare ID - Type Unspecified