Provider Demographics
NPI:1164619573
Name:NELSON, REBECCA LYNNE (AM, LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:AM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W BARRY AVE
Mailing Address - Street 2:2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7077
Mailing Address - Country:US
Mailing Address - Phone:773-420-7944
Mailing Address - Fax:
Practice Address - Street 1:4305 N LINCOLN AVE
Practice Address - Street 2:STE S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1711
Practice Address - Country:US
Practice Address - Phone:773-420-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0125861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical