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General NPI Number Information
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NPI Number | 1215049101
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Entity Type | Individual
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Provider Name | REBECCA EHRKE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 11457 OLDE CABIN RD SUITE 345
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City | CREVE COEUR
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State | MO
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Zip | 63141-7139
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Country | US
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Telephone | 847-754-7794
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Fax |
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Provider Business Mailing Address
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Address Line | 11457 OLDE CABIN RD STE 345 SUITE 345
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City | CREVE COEUR
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State | MO
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Zip | 63141-7192
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Country | US
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Telephone | 847-754-7794
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20-12001884
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License Number State | MO
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