Provider Demographics
NPI:1184734147
Name:HALL, REBECCA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14315 108TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5700
Mailing Address - Country:US
Mailing Address - Phone:708-669-3311
Mailing Address - Fax:
Practice Address - Street 1:14315 108TH AVE
Practice Address - Street 2:STE 220
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5700
Practice Address - Country:US
Practice Address - Phone:630-779-8525
Practice Address - Fax:708-403-6796
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178002308101Y00000X
IL071007445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623882OtherBCBS