Provider Demographics
NPI:1447388475
Name:OSBORN, REBECCA R (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 N GLENWOOD AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1804
Mailing Address - Country:US
Mailing Address - Phone:773-262-1391
Mailing Address - Fax:773-508-5687
Practice Address - Street 1:655 W IRVING PARK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3123
Practice Address - Country:US
Practice Address - Phone:773-230-6153
Practice Address - Fax:773-508-5687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635119OtherBCBS PROVIDER NUMBER