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General NPI Number Information
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NPI Number | 1174710032
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Entity Type | Individual
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Provider Name | REBECCA ELLEN GERDES M.S., D.T.
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Gender | Female
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 635 N GROVE AVE
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City | ELGIN
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State | IL
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Zip | 60120-2803
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Country | US
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Telephone | 630-440-1015
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Fax | 847-841-8529
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Provider Business Mailing Address
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Address Line | 635 N GROVE AVE
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City | ELGIN
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State | IL
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Zip | 60120-2803
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Country | US
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Telephone | 630-440-1015
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Fax | 847-841-8529
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | RG21470903P
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License Number State | IL
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