Provider Demographics
NPI:1346646122
Name:ROSE, REBECCA RENEA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RENEA
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RENEA
Other - Last Name:COTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:150 GLENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5700
Mailing Address - Country:US
Mailing Address - Phone:205-795-3266
Mailing Address - Fax:
Practice Address - Street 1:150 GLENWOOD LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5700
Practice Address - Country:US
Practice Address - Phone:205-795-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7315103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst