Provider Demographics
NPI:1194304915
Name:WRIGHT, REBECCA (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SAINT LOUIS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3028
Mailing Address - Country:US
Mailing Address - Phone:574-406-1520
Mailing Address - Fax:
Practice Address - Street 1:300 S SAINT LOUIS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3028
Practice Address - Country:US
Practice Address - Phone:574-406-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010138A104100000X
IN34011023A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker