Provider Demographics
NPI:1891415626
Name:EREBHOLO, RHODA
Entity type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:EREBHOLO
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 1:333 N LA GRANGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5653
Mailing Address - Country:US
Mailing Address - Phone:708-995-3855
Mailing Address - Fax:708-995-3886
Practice Address - Street 1:333 N LA GRANGE RD STE 1
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60526-5653
Practice Address - Country:US
Practice Address - Phone:708-995-3855
Practice Address - Fax:708-995-3886
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health