Provider Demographics
NPI:1235300294
Name:FATZINGER, REBEKAH LEE (LLP, LMSW)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:LEE
Last Name:FATZINGER
Suffix:
Gender:F
Credentials:LLP, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28143 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-9608
Mailing Address - Country:US
Mailing Address - Phone:269-624-6153
Mailing Address - Fax:
Practice Address - Street 1:803 W ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1108
Practice Address - Country:US
Practice Address - Phone:269-427-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006216103TC0700X
MI68010635741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical