Provider Demographics
NPI:1497232904
Name:REIGHARD, NATALIE JEAN (RBT)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:JEAN
Last Name:REIGHARD
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 1:91-1411 KEONEULA BLVD UNIT 2102
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6453
Mailing Address - Country:US
Mailing Address - Phone:208-651-8300
Mailing Address - Fax:
Practice Address - Street 1:91-1411 KEONEULA BLVD UNIT 2102
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6453
Practice Address - Country:US
Practice Address - Phone:208-651-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-18-61530106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty