Provider Demographics
NPI:1407353394
Name:WEAVER RIVERA, RACHEL (LCPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WEAVER RIVERA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5304
Mailing Address - Country:US
Mailing Address - Phone:773-203-6659
Mailing Address - Fax:
Practice Address - Street 1:125 WINDSOR DR STE 103
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4073
Practice Address - Country:US
Practice Address - Phone:773-203-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health