Provider Demographics
NPI:1750619318
Name:RUDOLPH, REBECCA (MS CADC LCPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:
Credentials:MS CADC LCPC
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9792 REDFIELD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7117
Mailing Address - Country:US
Mailing Address - Phone:815-354-0604
Mailing Address - Fax:
Practice Address - Street 1:16255 HARTMAN RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:IL
Practice Address - Zip Code:61019-9201
Practice Address - Country:US
Practice Address - Phone:815-354-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007114101YM0800X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)