Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 17392 | IL |
Y | 1041C0700X | Clinical Social Worker | 149002526 | IL |
NPI | 1013048636 |
---|---|
Provider Name | Peggy Lin Gibble |
First Address | Schaumburg, IL 60193-3965 |
Second Address | Schaumburg, IL 60193-3965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 11/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K46295 | (02) | IL |