Rebecca G Shreck, LISW, LCDCIII

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1801290 Issued in OH

Practice address

2029 Northcreek Dr
Englewood, OH 45322-2245

Phone

(937) 390-2121

NPI assigned

Jul 11, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Rebecca G Gehron Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1902258288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2029 NORTHCREEK DR",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453222245",
            "telephone_number": "937-390-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2029 NORTHCREEK DR",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453222245",
            "telephone_number": "937-390-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHRECK",
        "first_name": "REBECCA",
        "middle_name": "G",
        "credential": "LISW, LCDCIII",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.161419",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S1600343",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1801290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "GEHRON",
            "middle_name": "G",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Seema Sharma, M.D.
• Melinda Shaw
• Randolph S Shaw, DDS
• Ross D. Shira, DDS
• Shontae L Howard
• Amy Kathleen Shuttleworth, RPH
• Rachel Elizabeth Sidwell, MD
• Teresa Siefke, MS, AGACNP-BC
• Rebecca Irene Simpson
• Single Parents Rock

• Clinical Social Worker in Englewood, OH
• Providers in Englewood, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.