Healthcare Provider Details

I. General information

NPI: 1750828448
Provider Name (Legal Business Name): SARAH ANN CORWIN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 REMINGTON PLZ
RAYMORE MO
64083-8584
US

IV. Provider business mailing address

504 LIONS DR
PECULIAR MO
64078-9788
US

V. Phone/Fax

Practice location:
  • Phone: 816-730-8525
  • Fax:
Mailing address:
  • Phone: 816-345-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75355
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: