Provider Demographics
NPI:1346730041
Name:RZEPKA, JOANN ARDEN (RBT-18-55967)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:ARDEN
Last Name:RZEPKA
Suffix:
Gender:F
Credentials:RBT-18-55967
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45599 N STONEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6645
Mailing Address - Country:US
Mailing Address - Phone:734-612-1256
Mailing Address - Fax:
Practice Address - Street 1:45599 N STONEWOOD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-6645
Practice Address - Country:US
Practice Address - Phone:734-612-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18-55967106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician