MEDICARE: MRS. REBECCA ANN FLETCHER LCSW, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.012793	IL

General Provider Information

NPI Number	:	1619582525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA ANN FLETCHER LCSW, CADC

Provider Business Mailing Address
First Line	:	238 PROSPECT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2348
Country	:	US
Telephone Number	:	217-491-0741
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E MORGAN ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2587
Country	:	US
Telephone Number	:	217-245-1655
Fax Number	:	217-245-4742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	11/27/2023

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