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NPI Code Detail

MEDICARE: MRS. SARA GRIGSBY LBA, BCBA

MEDICARE: MRS. SARA GRIGSBY LBA, BCBA
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 Analyst7401001361MI
2106S00000XBehavior Technician
3171M00000XCase Manager/Care Coordinator
4103K00000XBehavior Analyst1-21-47130MI

General Provider Information

NPI Number : 1265826622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARA GRIGSBY LBA, BCBA
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 120 STEVENS ST SW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-1526
Country : US
Telephone Number : 518-867-5309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2015
Last Update Date : 08/17/2021

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