Provider Demographics
NPI:1003534215
Name:REYNOLDS, REBECCA J (MA, EDD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S WOLF RD APT 139
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1718
Mailing Address - Country:US
Mailing Address - Phone:847-346-7695
Mailing Address - Fax:
Practice Address - Street 1:1501 S WOLF RD APT 139
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1718
Practice Address - Country:US
Practice Address - Phone:847-346-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2119921OtherILLINOIS SCHOOL BOARD OF EDUCATION