Healthcare Provider Details

I. General information

NPI: 1508760570
Provider Name (Legal Business Name): REBEKKA MAE ASHLEE JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKKA BRENNAN LCPC

II. Dates (important events)

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

III. Provider practice location address

4043 N RAVENSWOOD AVE STE 302
CHICAGO IL
60613-5683
US

IV. Provider business mailing address

4043 N RAVENSWOOD AVE STE 302
CHICAGO IL
60613-5683
US

V. Phone/Fax

Practice location:
  • Phone: 312-967-4669
  • Fax:
Mailing address:
  • Phone: 312-967-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: