Provider Demographics
NPI:1023652567
Name:STAUFFER, REBECCA (MA, RD, LPC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:MA, RD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-0184
Mailing Address - Country:US
Mailing Address - Phone:719-351-0892
Mailing Address - Fax:
Practice Address - Street 1:306 1/2 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-351-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86034734133V00000X
COLPC.0016812101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered