Healthcare Provider Details

I. General information

NPI: 1881462745
Provider Name (Legal Business Name): NOAH REGNERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 TECHNY RD
NORTHBROOK IL
60062-5447
US

IV. Provider business mailing address

930 N FAIRFIELD AVE # 2
CHICAGO IL
60622-4453
US

V. Phone/Fax

Practice location:
  • Phone: 760-845-7858
  • Fax:
Mailing address:
  • Phone: 760-845-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.117722
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: