Provider Demographics
NPI:1922634112
Name:RAHN, REBECCA (PC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RAHN
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 JACKSON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2708
Mailing Address - Country:US
Mailing Address - Phone:414-534-1990
Mailing Address - Fax:
Practice Address - Street 1:4650 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-5908
Practice Address - Country:US
Practice Address - Phone:414-376-5577
Practice Address - Fax:414-762-9927
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4457-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional