Healthcare Provider Details

I. General information

NPI: 1750353736
Provider Name (Legal Business Name): REBECCA LYNN ANDERSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN BROWN M.S.

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 58TH ST # 505A
CHICAGO IL
60637-5415
US

IV. Provider business mailing address

920 E 58TH ST # 505A
CHICAGO IL
60637-5415
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-4016
  • Fax:
Mailing address:
  • Phone: 773-702-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number99042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: