Provider Demographics
NPI:1699439190
Name:WITT, REBECCA (CHNC, HHP, IHP, RDMS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:CHNC, HHP, IHP, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N16072 JUNCTION AVE
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-8003
Mailing Address - Country:US
Mailing Address - Phone:608-381-0441
Mailing Address - Fax:
Practice Address - Street 1:3119 GOLF RD STE 103
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7073
Practice Address - Country:US
Practice Address - Phone:715-828-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI