Provider Demographics
NPI:1457837205
Name:BISSON, REBECCA K (BA)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:K
Last Name:BISSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 68TH ST SW
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7179
Mailing Address - Country:US
Mailing Address - Phone:616-202-5161
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:346 68TH ST SW
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548-7179
Practice Address - Country:US
Practice Address - Phone:616-202-5161
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-19-90656106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRBT-19-90656OtherREGISTERED BEHAVIOR TECHNICIAN