Provider Demographics
NPI:1700113735
Name:RIENKS, FOEKE (MS , BCBA)
Entity Type:Individual
Prefix:
First Name:FOEKE
Middle Name:
Last Name:RIENKS
Suffix:
Gender:M
Credentials:MS , BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8011 PHILIPS HWY STE 10
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7459
Mailing Address - Country:US
Mailing Address - Phone:904-612-4524
Mailing Address - Fax:904-647-9489
Practice Address - Street 1:8011 PHILIPS HWY STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7459
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:904-647-9489
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-08-2622103K00000X
FL1-14-16577103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst