Provider Demographics
NPI:1750926796
Name:BOOTH, REBECCA JANE (LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 N 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3750
Mailing Address - Country:US
Mailing Address - Phone:319-774-2045
Mailing Address - Fax:866-496-4073
Practice Address - Street 1:215 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1844
Practice Address - Country:US
Practice Address - Phone:319-330-3696
Practice Address - Fax:866-496-4073
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker