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General NPI Number Information
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NPI Number | 1245328582
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Entity Type | Individual
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Provider Name | REBECCA GAMBLE HOUGLUM P.A.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 915 S WAUKEGAN RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2654
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Country | US
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Telephone | 847-234-8866
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Fax | 847-223-6098
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Provider Business Mailing Address
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Address Line | 915 S WAUKEGAN RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2654
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Country | US
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Telephone | 847-234-8866
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085-002288
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License Number State | IL
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