Healthcare Provider Details

I. General information

NPI: 1215850839
Provider Name (Legal Business Name): AVA REGINE RAPP LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 W PETERSON AVE STE 202
CHICAGO IL
60646-6183
US

IV. Provider business mailing address

6321 N AVONDALE AVE STE 204
CHICAGO IL
60631-1961
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-4444
  • Fax: 773-774-4447
Mailing address:
  • Phone: 773-774-4444
  • Fax: 773-774-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150101559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: