Provider Demographics
NPI:1497261432
Name:HASTINGS, ROXANNE (RBT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:HASTINGS
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 1:7456 S 1740 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6636
Mailing Address - Country:US
Mailing Address - Phone:801-923-8773
Mailing Address - Fax:844-965-9282
Practice Address - Street 1:7456 S 1740 E
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-6636
Practice Address - Country:US
Practice Address - Phone:801-923-8773
Practice Address - Fax:844-965-9282
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-15-00672106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician