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General NPI Number Information
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NPI Number | 1558979922
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Entity Type | Individual
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Provider Name | REBECCA VADEN
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 12437 LEWIS ST STE 100
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4651
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Country | US
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Telephone | 714-202-0118
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Fax |
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Provider Business Mailing Address
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Address Line | 12437 LEWIS ST STE 100
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4651
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Country | US
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Telephone | 714-202-0118
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 00011715
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-62065
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-22-13564
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License Number State | CA
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