Provider Demographics
NPI:1376892034
Name:RAEBIG, ROSEMARY (MHS,CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:RAEBIG
Suffix:
Gender:F
Credentials:MHS,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6775 PROSPERI DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4789
Mailing Address - Country:US
Mailing Address - Phone:708-478-1414
Mailing Address - Fax:708-478-7786
Practice Address - Street 1:7600 W 170TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2475
Practice Address - Country:US
Practice Address - Phone:708-802-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist