Provider Demographics
NPI:1184090730
Name:GOSSAN, RACHEL KOMMIT (MA, BCBA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:KOMMIT
Last Name:GOSSAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:KOMMIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:1000 E PARIS AVE SE STE 155
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8313
Mailing Address - Country:US
Mailing Address - Phone:231-668-4909
Mailing Address - Fax:
Practice Address - Street 1:4433 W TOUHY AVE
Practice Address - Street 2:SUIT 335
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1820
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst