Provider Demographics
NPI:1255106241
Name:ADOLPHSON, REBEKAH ANN (LMSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:ADOLPHSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ANN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4403 1ST AVE SE STE 500
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3221
Mailing Address - Country:US
Mailing Address - Phone:319-200-5670
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE STE 500
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3221
Practice Address - Country:US
Practice Address - Phone:319-200-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119002104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty