Provider Demographics
NPI:1841549565
Name:WEBER, REGINA MAE (MS)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MAE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MAE
Other - Last Name:KOHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 REVERE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1590
Mailing Address - Country:US
Mailing Address - Phone:877-552-6672
Mailing Address - Fax:
Practice Address - Street 1:175 N CORPORATE DR STE 150
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5899
Practice Address - Country:US
Practice Address - Phone:877-552-6672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60587896101YM0800X
WI6375-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional