Provider Demographics
NPI:1457010738
Name:LOHSE, REBECCA (LPC-IT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:LOHSE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 WILGUS AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3754
Mailing Address - Country:US
Mailing Address - Phone:920-698-7525
Mailing Address - Fax:
Practice Address - Street 1:805 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4113
Practice Address - Country:US
Practice Address - Phone:920-457-8866
Practice Address - Fax:920-457-8867
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8614-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100091783Medicaid