Individual
REBECCA J WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 FAYETTE ST, PEORIA, IL 61603-3610
(309) 671-8019
(309) 671-4695
Mailing address
PO BOX 1346, PEORIA, IL 61654-1346
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
209008803
IL
101YM0800X
Mental Health Counselor
209008803
IL
363L00000X
Nurse Practitioner
Primary
209008803
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209008803
DIVISION OF PROFESSIONAL REGULATION
IL
Enumeration date
07/12/2011
Last updated
05/17/2012
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