Healthcare Provider Details

I. General information

NPI: 1073574992
Provider Name (Legal Business Name): REBECCA D ANDERSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 OLD JACKSONVILLE RD SUITE 140
SPRINGFIELD IL
62704-7400
US

IV. Provider business mailing address

3132 OLD JACKSONVILLE RD SUITE 140
SPRINGFIELD IL
62704-7400
US

V. Phone/Fax

Practice location:
  • Phone: 217-862-0400
  • Fax: 217-862-0440
Mailing address:
  • Phone: 217-862-0400
  • Fax: 217-862-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: