Provider Demographics
NPI:1801010509
Name:MOWERS, REBECCA SUE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:MOWERS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 HAWKINSON AVE
Mailing Address - Street 2:APT-5
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2486
Mailing Address - Country:US
Mailing Address - Phone:309-238-0322
Mailing Address - Fax:
Practice Address - Street 1:516 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2311
Practice Address - Country:US
Practice Address - Phone:309-836-6500
Practice Address - Fax:309-836-6506
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150011068104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370984175OtherBRIDGEWAY INC FEIN
IL091578101OtherMASTERS TEST ID