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General NPI Number Information
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NPI Number | 1245047976
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Entity Type | Individual
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Provider Name | EMILY REBSTOCK LSW
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 540 W FRONTAGE RD STE 2235
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City | NORTHFIELD
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State | IL
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Zip | 60093-1228
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Country | US
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Telephone | 815-496-0620
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Fax |
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Provider Business Mailing Address
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Address Line | 711 DOBSON ST APT 1
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City | EVANSTON
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State | IL
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Zip | 60202-5255
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Country | US
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Telephone | 224-475-5551
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150.115493
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License Number State | IL
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