Basic Information
| Provider Information | |||||||||
| NPI: | 1184090730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOSSAN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | KOMMIT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.A., BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KOMMIT | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.A., BCBA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1000 E PARIS AVE SE STE 155 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495468313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316684909 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4433 W TOUHY AVE | ||||||||
| Address2: | SUIT 335 | ||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774864140 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.