Provider Demographics
NPI:1235899600
Name:RYBACKI, STACI LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:LYNN
Last Name:RYBACKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 N GILBERT RD STE C100
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4736
Mailing Address - Country:US
Mailing Address - Phone:480-734-3851
Mailing Address - Fax:480-632-0026
Practice Address - Street 1:459 N GILBERT RD STE C100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4736
Practice Address - Country:US
Practice Address - Phone:480-734-3851
Practice Address - Fax:480-632-0026
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-15-18942103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1225206444Medicaid