Provider Demographics
NPI:1114677606
Name:WEBER, REGINA EMILY (LCPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:EMILY
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S WESTLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4620
Mailing Address - Country:US
Mailing Address - Phone:630-488-9386
Mailing Address - Fax:
Practice Address - Street 1:30 S WESTLAWN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4620
Practice Address - Country:US
Practice Address - Phone:630-488-9386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional