Provider Demographics
NPI:1750087912
Name:REHOVSKY-BENNEWITZ, ALEXANDRA (PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:REHOVSKY-BENNEWITZ
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 1:7622 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1403
Mailing Address - Country:US
Mailing Address - Phone:320-224-9019
Mailing Address - Fax:
Practice Address - Street 1:4700 W 95TH ST STE LL5
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2575
Practice Address - Country:US
Practice Address - Phone:320-224-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011176103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty