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NPI Code Detail

MEDICARE: REBEKAH NORTH BCBA

MEDICARE: REBEKAH NORTH BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-21-50486CO

General Provider Information

NPI Number : 1407327539
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBEKAH NORTH BCBA
Provider Business Mailing Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-565-1276
Fax Number : 719-565-2313
Provider Business Practice Location Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-565-1276
Fax Number : 719-565-2313
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2018
Last Update Date : 07/22/2021

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