Provider Demographics
NPI:1356189971
Name:PEREZ, JOANNA (RBT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5475 KNOLL PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8044
Mailing Address - Country:US
Mailing Address - Phone:888-924-2366
Mailing Address - Fax:888-263-5638
Practice Address - Street 1:1300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3330
Practice Address - Country:US
Practice Address - Phone:888-924-2366
Practice Address - Fax:888-263-5638
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYRBT-24-319771106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician