Provider Demographics
NPI:1063905412
Name:ROWE, REBEKAH JADE (MA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JADE
Last Name:ROWE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:JADE
Other - Last Name:NOACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3562 E US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-6720
Mailing Address - Country:US
Mailing Address - Phone:574-376-4489
Mailing Address - Fax:
Practice Address - Street 1:3562 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-6720
Practice Address - Country:US
Practice Address - Phone:574-376-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004572A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health