Doctor Name: | REBECA G ACKERMANN |
NPI Number: | 1013267897 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSED, LMFT |
License Number: | |
Business Practice Address: | 2100 Goshen Rd Fort Wayne, IN - 468081493 |
Business Phone Number: | 2604713500 |
Business Fax Number: | 2604714263 |
Mailing Address: | 2621 E Jefferson St, C/o Anne Lawson - Credentialing WARSAW |
State: | IN |
Postal Code: | 465803880 |
Phone Number: | 5742690573 |
Fax Number: | 5742690573 |
NPI Enumeration Date: | 09/19/2012 |
NPI Last Update Date: | 11/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |