Provider Demographics
NPI:1255708558
Name:GILLOGLY, REBECCA ANNE (PSYD, MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:GILLOGLY
Suffix:
Gender:F
Credentials:PSYD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 F ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1609
Mailing Address - Country:US
Mailing Address - Phone:805-791-6372
Mailing Address - Fax:
Practice Address - Street 1:1508 F ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1609
Practice Address - Country:US
Practice Address - Phone:805-791-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104528106H00000X
CA33914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist