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NPI Code Detail

MEDICARE: MRS. SARA NICOLE DODSON BCBA

MEDICARE: MRS. SARA NICOLE DODSON BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1003330432
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARA NICOLE DODSON BCBA
Provider Business Mailing Address
First Line : 640 FARM LN
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-1600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1107 E GRAND RIVER AVE
Second Line :
City : LANSING
State : MI
Zip : 48906-5457
Country : US
Telephone Number : 517-404-0252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2017
Last Update Date : 07/27/2017

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