Healthcare Provider Details

I. General information

NPI: 1144165275
Provider Name (Legal Business Name): REBECCA EMILY BACON EHLERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 WOODWARD AVE
DOWNERS GROVE IL
60515-2633
US

IV. Provider business mailing address

4512 WOODWARD AVE
DOWNERS GROVE IL
60515-2633
US

V. Phone/Fax

Practice location:
  • Phone: 630-901-7455
  • Fax:
Mailing address:
  • Phone: 630-901-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031038
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: