Healthcare Provider Details

I. General information

NPI: 1053954529
Provider Name (Legal Business Name): REBECCA MUIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA BURK

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROOSEVELT RD STE 206
GLEN ELLYN IL
60137-5839
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 630-423-5935
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: