Provider Demographics
NPI:1053326546
Name:MUELLER, REBECCA SUSAN (PSYD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUSAN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1701
Mailing Address - Country:US
Mailing Address - Phone:847-492-8230
Mailing Address - Fax:847-492-8201
Practice Address - Street 1:719 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1701
Practice Address - Country:US
Practice Address - Phone:847-492-8230
Practice Address - Fax:847-492-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001623143OtherBCBS