Provider Demographics
NPI:1598181877
Name:REHAK, KIMBERLY L (EDD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:REHAK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:KIRCHER-REHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, BCBA
Mailing Address - Street 1:583 SHOEMAKER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4238
Mailing Address - Country:US
Mailing Address - Phone:484-681-2170
Mailing Address - Fax:
Practice Address - Street 1:583 SHOEMAKER RD STE 230
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4238
Practice Address - Country:US
Practice Address - Phone:484-681-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2024-01-04
Deactivation Date:2018-09-13
Deactivation Code:
Reactivation Date:2023-12-19
Provider Licenses
StateLicense IDTaxonomies
PA1-07-3573103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst