Provider Demographics
NPI:1255455838
Name:GADOMSKI, REBECCA ANNE (LSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:GADOMSKI
Suffix:
Gender:F
Credentials:LSW, LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:WIET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8S744 WAYEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-9232
Mailing Address - Country:US
Mailing Address - Phone:630-873-9052
Mailing Address - Fax:630-428-7891
Practice Address - Street 1:2948 ARTESIAN RD STE 112
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8559
Practice Address - Country:US
Practice Address - Phone:630-428-7890
Practice Address - Fax:630-428-7891
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490117181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical