Healthcare Provider Details

I. General information

NPI: 1265199327
Provider Name (Legal Business Name): REBECCA ALICE WANG LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ENCINAS LISW

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EAGLE DR STE A
MINSTER OH
45865-9714
US

IV. Provider business mailing address

4 EAGLE DR STE A
MINSTER OH
45865-9714
US

V. Phone/Fax

Practice location:
  • Phone: 419-628-6156
  • Fax:
Mailing address:
  • Phone: 419-628-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2203721
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: