Provider Demographics
NPI:1356021315
Name:WILSON, REBECCA LEVATER (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEVATER
Last Name:WILSON
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 S EAST END AVE APT 1602N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-0112
Mailing Address - Country:US
Mailing Address - Phone:770-743-8471
Mailing Address - Fax:
Practice Address - Street 1:5035 S EAST END AVE APT 1602N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-0112
Practice Address - Country:US
Practice Address - Phone:770-743-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management