Healthcare Provider Details

I. General information

NPI: 1548931520
Provider Name (Legal Business Name): MELISSA GONZALEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 W CHICAGO ST
RAPID CITY SD
57702-2467
US

IV. Provider business mailing address

2475 W CHICAGO ST
RAPID CITY SD
57702-2467
US

V. Phone/Fax

Practice location:
  • Phone: 605-206-5004
  • Fax: 605-646-4840
Mailing address:
  • Phone: 605-206-5004
  • Fax: 605-646-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: