=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396554366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH E PARKER MA, BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2025
-----------------------------------------------------
Last Update Date | 01/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6737 W WASHINGTON ST STE 3115
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-256-0077
-----------------------------------------------------
Fax | 414-256-0090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6737 W WASHINGTON ST STE 3115
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-256-0077
-----------------------------------------------------
Fax | 414-256-0090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1328-140
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------