Provider Demographics
NPI:1245444686
Name:WELLMAN, REBECCA LYNN (PHD, MT-BC, DT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:PHD, MT-BC, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-1743
Mailing Address - Country:US
Mailing Address - Phone:630-890-1113
Mailing Address - Fax:
Practice Address - Street 1:314 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-1743
Practice Address - Country:US
Practice Address - Phone:630-890-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist