Provider Demographics
NPI:1013267897
Name:ACKERMANN, REBECA G (MSED, LMFT)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:G
Last Name:ACKERMANN
Suffix:
Gender:F
Credentials:MSED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:C/O ANNE LAWSON - CREDENTIALING
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:574-269-0573
Mailing Address - Fax:574-269-0573
Practice Address - Street 1:2100 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1493
Practice Address - Country:US
Practice Address - Phone:260-471-3500
Practice Address - Fax:260-471-4263
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN35001855A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health