Provider Demographics
NPI:1376142950
Name:FITZGERALD, REBECCA (RBT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 N HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-2324
Mailing Address - Country:US
Mailing Address - Phone:507-825-5858
Mailing Address - Fax:
Practice Address - Street 1:1314 N HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-2324
Practice Address - Country:US
Practice Address - Phone:507-825-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDRBT-19-78592106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician