Provider Demographics
NPI:1659007763
Name:EARL, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:EARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W CACHE VALLEY BLVD STE 5C
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-8475
Mailing Address - Country:US
Mailing Address - Phone:435-538-2152
Mailing Address - Fax:435-625-6237
Practice Address - Street 1:40 W CACHE VALLEY BLVD STE 5C
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-8475
Practice Address - Country:US
Practice Address - Phone:435-538-2152
Practice Address - Fax:435-625-6237
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical