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NPI Code Detail

MEDICARE: SARAH GAMMON M.S., BCBA, LBA

MEDICARE: SARAH GAMMON M.S., BCBA, LBA
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 Analyst3174TX
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1093265324
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH GAMMON M.S., BCBA, LBA
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 5022 TENNYSON PKWY
Second Line :
City : PLANO
State : TX
Zip : 75024-3151
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2016
Last Update Date : 07/19/2024

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