Provider Demographics
NPI:1235760125
Name:NOSBUSCH, REBECCA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NOSBUSCH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72319 570TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-3266
Mailing Address - Country:US
Mailing Address - Phone:507-350-1339
Mailing Address - Fax:
Practice Address - Street 1:1801 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334
Practice Address - Country:US
Practice Address - Phone:800-592-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN267671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical