Healthcare Provider Details

I. General information

NPI: 1104311745
Provider Name (Legal Business Name): PEGGY LONGMAN KEPPLE MSW,LCSW, CADC, GC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARGARET MARIE LONGMAN

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 05/23/2020
Certification Date: 05/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

POSITIVE SOBRIETY INSTITUTE 680 N. LAKE SHORE DR. SUITE 800
CHICAGO IL
60611
US

IV. Provider business mailing address

RIVERMEND HEALTH / POSITIVE SOBRIETY INSTITUTE 680 N. LAKESHORE DR. SUITE 800
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-7230
  • Fax: 312-642-7055
Mailing address:
  • Phone: 312-642-7230
  • Fax: 312-642-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number34557
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.022225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: