MEDICARE: PEGGY B RAABE LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180-001720	IL

General Provider Information

NPI Number	:	1508844150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY B RAABE LCPC

Provider Business Mailing Address
First Line	:	3900 WOOD DUCK DR STE B
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7048
Country	:	US
Telephone Number	:	217-679-0356
Fax Number	:	217-670-1688

Provider Business Practice Location Address
First Line	:	3900 WOOD DUCK DR STE B
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7048
Country	:	US
Telephone Number	:	217-679-0356
Fax Number	:	217-670-1688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	11/20/2024

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