Provider Demographics
NPI:1699231381
Name:HARTZELL, REBECCA IONE (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:IONE
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 W SONGBUSH PL
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4725
Mailing Address - Country:US
Mailing Address - Phone:520-429-3839
Mailing Address - Fax:
Practice Address - Street 1:3559 W SONGBUSH PL
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4725
Practice Address - Country:US
Practice Address - Phone:520-429-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000423103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst