Healthcare Provider Details

I. General information

NPI: 1316686991
Provider Name (Legal Business Name): TABATHA JOHN PRICE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 MCDOWELL RD UNIT 305
NAPERVILLE IL
60563
US

IV. Provider business mailing address

2441 PLAINFIELD RD
JOLIET IL
60435-1439
US

V. Phone/Fax

Practice location:
  • Phone: 630-689-1022
  • Fax:
Mailing address:
  • Phone: 630-815-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1316686991
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: