Provider Demographics
NPI:1568784114
Name:THOMPSON, REBECCA LYNN (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:150 N SUNNY SLOPE RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4806
Mailing Address - Country:US
Mailing Address - Phone:262-432-5660
Mailing Address - Fax:262-432-5666
Practice Address - Street 1:150 N SUNNY SLOPE RD
Practice Address - Street 2:SUITE #100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4806
Practice Address - Country:US
Practice Address - Phone:262-432-5660
Practice Address - Fax:262-432-5666
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2916-57103TC0700X
WI59-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568784114Medicaid