Provider Demographics
NPI:1699466466
Name:HUEY, REBECCA JEANNE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEANNE
Last Name:HUEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 PROFESSIONAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3015
Mailing Address - Country:US
Mailing Address - Phone:707-483-9061
Mailing Address - Fax:
Practice Address - Street 1:2230 PROFESSIONAL DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3015
Practice Address - Country:US
Practice Address - Phone:707-483-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111328104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker