Provider Demographics
NPI:1649529660
Name:LA PRADE, REBECCA (PHD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:LA PRADE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N HUDSON AVE UNIT 1102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6702
Mailing Address - Country:US
Mailing Address - Phone:602-743-1014
Mailing Address - Fax:
Practice Address - Street 1:750 N HUDSON AVE UNIT 1102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6702
Practice Address - Country:US
Practice Address - Phone:602-743-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist