Healthcare Provider Details

I. General information

NPI: 1255455838
Provider Name (Legal Business Name): REBECCA ANNE GADOMSKI LSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ANNE WIET LCSW

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/15/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 ARTESIAN RD STE 112
NAPERVILLE IL
60564-8559
US

IV. Provider business mailing address

8S744 WAYEWOOD LN
NAPERVILLE IL
60565-9232
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax: 630-428-7891
Mailing address:
  • Phone: 630-873-9052
  • Fax: 630-428-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149011718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: