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NPI Code Detail

MEDICARE: MS. REBECCA WIESENTHAL MSW,LSW

MEDICARE:  MS. REBECCA  WIESENTHAL  MSW,LSW
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
1104100000XSocial Worker150114229IL

General Provider Information

NPI Number : 1538053061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBECCA WIESENTHAL MSW,LSW
Provider Business Mailing Address
First Line : 3926 W TOUHY AVE STE 277
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-1028
Country : US
Telephone Number : 872-216-1156
Fax Number :
Provider Business Practice Location Address
First Line : 2700 W BIRCHWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1302
Country : US
Telephone Number : 872-216-1156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2025
Last Update Date : 06/09/2025

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Directions to “ MS. REBECCA WIESENTHAL MSW,LSW” Practice Location

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