MEDICARE: SAVANNAH RUTH KOONTZ MS, BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-001425	AZ
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1033824685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH RUTH KOONTZ MS, BCBA, LBA

Provider Business Mailing Address
First Line	:	3910 S ALMA SCHOOL RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4498
Country	:	US
Telephone Number	:	602-926-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7435 NEW TECHNOLOGY WAY STE B
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-9404
Country	:	US
Telephone Number	:	202-420-8359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/07/2026

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