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General NPI Number Information
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NPI Number | 1760903587
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Entity Type | Organization
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Legal Business Name | SAGE COLLECTIVE LEARNING CONSULTANTS
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Dates
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Enumeration Date | 07/01/2017
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 2435 PYRAMID WAY STE B
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City | SPARKS
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State | NV
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Zip | 89431-1865
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Country | US
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Telephone | 775-657-8309
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 PYRAMID WAY STE B
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City | SPARKS
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State | NV
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Zip | 89431-1865
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Country | US
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Telephone | 775-657-8309
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER/CEO
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Name | JENNIFER A C BONOW
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Credential |
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Telephone | 775-657-8309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA0100
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License Number State | NV
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