Healthcare Provider Details

I. General information

NPI: 1306767462
Provider Name (Legal Business Name): REBECKA BONNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 S STATE ST
CHICAGO IL
60609-3701
US

IV. Provider business mailing address

1410 S MORGAN ST
CHICAGO IL
60608-2220
US

V. Phone/Fax

Practice location:
  • Phone: 773-245-1446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: