Healthcare Provider Details

I. General information

NPI: 1659524874
Provider Name (Legal Business Name): REBECCA NAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 W OAKDALE AVE APT #202
CHICAGO IL
60657-4354
US

IV. Provider business mailing address

1049 W OAKDALE AVE APT #202
CHICAGO IL
60657-4354
US

V. Phone/Fax

Practice location:
  • Phone: 773-403-5911
  • Fax:
Mailing address:
  • Phone: 773-403-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: