Healthcare Provider Details

I. General information

NPI: 1669304184
Provider Name (Legal Business Name): RAWAN HAMZEH RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W WASHINGTON ST
BELLEVILLE IL
62220-2023
US

IV. Provider business mailing address

9 DOTTIE DR
BELLEVILLE IL
62223-3250
US

V. Phone/Fax

Practice location:
  • Phone: 618-905-0404
  • Fax:
Mailing address:
  • Phone: 618-802-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-541283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: