Provider Demographics
NPI:1528563921
Name:TACELOSKY, REBECCAH S
Entity Type:Individual
Prefix:
First Name:REBECCAH
Middle Name:S
Last Name:TACELOSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13248 MOGADORE AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7215
Mailing Address - Country:US
Mailing Address - Phone:443-677-9922
Mailing Address - Fax:
Practice Address - Street 1:13248 MOGADORE AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7215
Practice Address - Country:US
Practice Address - Phone:443-677-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.9016351041C0700X
OHI.19016351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical