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NPI Code Detail

MEDICARE: MISS REBECCA K BISSON B.A.

MEDICARE: MISS REBECCA K BISSON B.A.
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
1106S00000XBehavior TechnicianRBT-19-90656AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-19-90656OTHERAZREGISTERED BEHAVIOR TECHNICIAN

General Provider Information

NPI Number : 1457837205
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS REBECCA K BISSON B.A.
Provider Business Mailing Address
First Line : 346 68TH ST SW
Second Line :
City : KENTWOOD
State : MI
Zip : 49548-7179
Country : US
Telephone Number : 616-202-5161
Fax Number : 248-712-4381
Provider Business Practice Location Address
First Line : 346 68TH ST SW
Second Line :
City : KENTWOOD
State : MI
Zip : 49548-7179
Country : US
Telephone Number : 616-202-5161
Fax Number : 248-712-4381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2018
Last Update Date : 11/01/2021

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49548-7179
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1649747783 — RITA HILARI HERNANDEZ HS
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49548-7179
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1487211926 — SARAH HENKEL M.A., BCBA, LBA
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Directions to “ MISS REBECCA K BISSON B.A.” Practice Location

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