Provider Demographics
NPI:1326715673
Name:RYBARCZYK, BETHANY RAE (BCBA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:RAE
Last Name:RYBARCZYK
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 1:4002 STERNBERG AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2662
Mailing Address - Country:US
Mailing Address - Phone:715-432-2909
Mailing Address - Fax:
Practice Address - Street 1:1542 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3842
Practice Address - Country:US
Practice Address - Phone:715-916-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-21-52231103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst