Provider Demographics
NPI:1124501424
Name:HILL, REBEKAH ANN (MSW, LSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:HILL
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ANN
Other - Last Name:JAENICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7209 ENGLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2238
Mailing Address - Country:US
Mailing Address - Phone:260-484-4600
Mailing Address - Fax:260-484-4002
Practice Address - Street 1:7209 ENGLE RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2238
Practice Address - Country:US
Practice Address - Phone:260-484-4600
Practice Address - Fax:260-484-4002
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
IN33008747A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33008747AOtherSOCIAL WORK LICENSE (LSW)