Healthcare Provider Details

I. General information

NPI: 1447344171
Provider Name (Legal Business Name): REBECCA BENSFIELD M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 WEST 27TH STREET
NORTH RIVERSIDE IL
60546
US

IV. Provider business mailing address

8130 WEST 27TH STREET
NORTH RIVERSIDE IL
60546
US

V. Phone/Fax

Practice location:
  • Phone: 708-906-5478
  • Fax: 708-354-0867
Mailing address:
  • Phone: 708-906-5478
  • Fax: 708-354-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.005688
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008382
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: