Provider Demographics
NPI:1972344125
Name:YANNUZZI, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:YANNUZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 NORTHCOTE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9503
Mailing Address - Country:US
Mailing Address - Phone:219-381-8766
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1615
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3722
Practice Address - Country:US
Practice Address - Phone:312-767-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty