Healthcare Provider Details

I. General information

NPI: 1457010738
Provider Name (Legal Business Name): REBECCA LOHSE LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N 6TH ST
SHEBOYGAN WI
53081-4113
US

IV. Provider business mailing address

2612 WILGUS AVE
SHEBOYGAN WI
53081-3754
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-8866
  • Fax: 920-457-8867
Mailing address:
  • Phone: 920-698-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8614-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: