Provider Demographics
NPI:1750507968
Name:LAMBERT, REBECCA AMELIA (MSED)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:AMELIA
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 145
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-9341
Mailing Address - Country:US
Mailing Address - Phone:618-423-9201
Mailing Address - Fax:618-423-9201
Practice Address - Street 1:RR 3 BOX 145
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-9341
Practice Address - Country:US
Practice Address - Phone:618-423-9201
Practice Address - Fax:618-423-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRM51660198P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist