Provider Demographics
NPI:1740916931
Name:KOHL, REBECCA LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:KOHL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 SUGAR PLUM CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1724
Mailing Address - Country:US
Mailing Address - Phone:712-363-4132
Mailing Address - Fax:
Practice Address - Street 1:4806 SUGAR PLUM CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1724
Practice Address - Country:US
Practice Address - Phone:712-363-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst