MEDICARE: DR. REBECCA J REYNOLDS MA, EDD

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	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2119921	OTHER	IL	ILLINOIS SCHOOL BOARD OF EDUCATION

General Provider Information

NPI Number	:	1003534215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA J REYNOLDS MA, EDD

Provider Business Mailing Address
First Line	:	1501 S WOLF RD APT 139
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1718
Country	:	US
Telephone Number	:	847-346-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 S WOLF RD APT 139
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1718
Country	:	US
Telephone Number	:	847-346-7695
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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