Provider Demographics
NPI:1538053061
Name:WIESENTHAL, REBECCA (MSW,LSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:WIESENTHAL
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 W TOUHY AVE STE 277
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1028
Mailing Address - Country:US
Mailing Address - Phone:872-216-1156
Mailing Address - Fax:
Practice Address - Street 1:2700 W BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1302
Practice Address - Country:US
Practice Address - Phone:872-216-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150114229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker