Provider Demographics
NPI:1730758319
Name:OLESKO, REBEKAH FAITH
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:FAITH
Last Name:OLESKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:FAITH
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11245 S HARLEM AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1844
Mailing Address - Country:US
Mailing Address - Phone:262-744-1111
Mailing Address - Fax:
Practice Address - Street 1:8505 183RD ST STE D
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-3706
Practice Address - Country:US
Practice Address - Phone:708-864-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician