Provider Demographics
NPI:1326880030
Name:BARRY, REBEKAH L (MS)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:L
Last Name:BARRY
Suffix:
Gender:X
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S GARDENS WAY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7667
Mailing Address - Country:US
Mailing Address - Phone:480-276-0956
Mailing Address - Fax:
Practice Address - Street 1:6300 UNIVERSITY AVE STE 125
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3486
Practice Address - Country:US
Practice Address - Phone:608-237-8000
Practice Address - Fax:608-237-8005
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1098228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist