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General NPI Number Information
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NPI Number | 1023716933
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Entity Type | Individual
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Provider Name | REVA REKOWSKI
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 2524 GOLF RD APT 2F
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City | EAU CLAIRE
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State | WI
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Zip | 54701-8068
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Country | US
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Telephone | 715-598-1832
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Fax |
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Provider Business Mailing Address
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Address Line | 10567 COUNTY HIGHWAY S S
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-5200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1077-140
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License Number State | WI
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