Provider Demographics
NPI:1760043236
Name:CARTER, REBEKAH
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:NESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 W ROOSEVELT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-4819
Mailing Address - Country:US
Mailing Address - Phone:888-308-3728
Mailing Address - Fax:630-429-9123
Practice Address - Street 1:117 GLEN CROSSING RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1405
Practice Address - Country:US
Practice Address - Phone:888-308-3728
Practice Address - Fax:630-429-9123
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-36177103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst