Healthcare Provider Details

I. General information

NPI: 1104190438
Provider Name (Legal Business Name): REBECCA MARIE GEBHART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 W NORTH AVE
CHICAGO IL
60647-5216
US

IV. Provider business mailing address

2542 W NORTH AVE
CHICAGO IL
60647-5216
US

V. Phone/Fax

Practice location:
  • Phone: 773-365-7277
  • Fax:
Mailing address:
  • Phone: 773-365-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: