Provider Demographics
NPI:1164227336
Name:KHOLODOVSKY, REBECCA ELIZABETH
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:KHOLODOVSKY
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 1:433 FARNSWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:PORT BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1079
Mailing Address - Country:US
Mailing Address - Phone:847-691-5244
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9164
Practice Address - Country:US
Practice Address - Phone:847-691-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor