Provider Demographics
NPI:1144554510
Name:RITENOUR, TABATHA ELAINE (PSYD)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:ELAINE
Last Name:RITENOUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TABATHA
Other - Middle Name:ELAINE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28594 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:2285 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-6209
Practice Address - Country:US
Practice Address - Phone:630-906-5120
Practice Address - Fax:630-906-5093
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL576560Medicare PIN