1619582525 NPI number — MRS. REBECCA ANN FLETCHER LCSW, CADC

Table of content: MRS. REBECCA ANN FLETCHER LCSW, CADC (NPI 1619582525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619582525 NPI number — MRS. REBECCA ANN FLETCHER LCSW, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
REBECCA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARD
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, CADC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619582525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E MORGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62650-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-245-1655
Provider Business Practice Location Address Fax Number:
217-245-4742
Provider Enumeration Date:
09/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.012793 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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