Healthcare Provider Details

I. General information

NPI: 1417886888
Provider Name (Legal Business Name): KERSTIN NICOLE REWERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 N ALPINE RD STE 103
MACHESNEY PARK IL
61115-8362
US

IV. Provider business mailing address

7477 BELL VISTA TER
ROCKFORD IL
61107-2779
US

V. Phone/Fax

Practice location:
  • Phone: 815-200-6444
  • Fax: 815-201-1702
Mailing address:
  • Phone: 815-299-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: