Healthcare Provider Details

I. General information

NPI: 1841549565
Provider Name (Legal Business Name): REGINA MAE WEBER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA MAE KOHORST

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N CORPORATE DR STE 150
BROOKFIELD WI
53045-5899
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 877-552-6672
  • Fax:
Mailing address:
  • Phone: 877-552-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60587896
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6375-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: