Healthcare Provider Details

I. General information

NPI: 1285721845
Provider Name (Legal Business Name): REBECCA ANJANETTE STREETER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ANJANETTE WEIKLE LCSW

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 TOMMYDON ST
STOCKTON CA
95210-3364
US

IV. Provider business mailing address

13 WHISPERING WAY
LODI CA
95242-9563
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-4096
  • Fax:
Mailing address:
  • Phone: 209-747-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: