Healthcare Provider Details

I. General information

NPI: 1033824685
Provider Name (Legal Business Name): SAVANNAH RUTH KOONTZ MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 NEW TECHNOLOGY WAY STE B
FREDERICK MD
21703-9404
US

IV. Provider business mailing address

3910 S ALMA SCHOOL RD
CHANDLER AZ
85248-4498
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-8359
  • Fax:
Mailing address:
  • Phone: 602-926-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001425
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: