Healthcare Provider Details

I. General information

NPI: 1407406184
Provider Name (Legal Business Name): SARAH STUPARITS MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH DANIELS

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 72ND AVE
PLEASANT PRAIRIE WI
53158-2911
US

IV. Provider business mailing address

10450 72ND AVE
PLEASANT PRAIRIE WI
53158-2911
US

V. Phone/Fax

Practice location:
  • Phone: 262-657-6453
  • Fax: 262-671-5013
Mailing address:
  • Phone: 262-657-6453
  • Fax: 262-671-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1297140
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: