Healthcare Provider Details

I. General information

NPI: 1255856779
Provider Name (Legal Business Name): REBECCA VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N OAKLEY BLVD
CHICAGO IL
60622-3507
US

IV. Provider business mailing address

5053 W SCHUBERT AVE
CHICAGO IL
60639-1605
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2317
  • Fax:
Mailing address:
  • Phone: 773-430-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: