Basic Information
| Provider Information | |||||||||
| NPI: | 1427515048 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | REBACK | ||||||||
| FirstName: | ISABEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 STEWART ST | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981013311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069875223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51 W 3900 S | ||||||||
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| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841071431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015872370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2019 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 61365864 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.