Provider Demographics
NPI:1831775865
Name:PEPPMULLER, TABITHA (LCSW)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:PEPPMULLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:NORLDOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:434 S THIRD ST
Mailing Address - Street 2:
Mailing Address - City:PEOTONE
Mailing Address - State:IL
Mailing Address - Zip Code:60468-9251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:434 S THIRD ST
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468-9251
Practice Address - Country:US
Practice Address - Phone:630-335-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0203101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical