Provider Demographics
NPI:1366195299
Name:REBOLLAR, GABRIELA (LSW, MSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:REBOLLAR
Suffix:
Gender:F
Credentials:LSW, MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-1218
Mailing Address - Country:US
Mailing Address - Phone:815-210-1630
Mailing Address - Fax:
Practice Address - Street 1:220 CHANNAHON ST
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-9330
Practice Address - Country:US
Practice Address - Phone:815-714-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106253104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker