Provider Demographics
NPI:1811616394
Name:HASSEBROCK, REBECCA GRACE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GRACE
Last Name:HASSEBROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 MILLER TRUNK HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4448
Mailing Address - Country:US
Mailing Address - Phone:218-524-8889
Mailing Address - Fax:
Practice Address - Street 1:1702 MILLER TRUNK HWY STE 209
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4448
Practice Address - Country:US
Practice Address - Phone:218-524-8889
Practice Address - Fax:218-524-8890
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist