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NPI Code Detail

MEDICARE: ETHAN SAGE

MEDICARE: ETHAN SAGE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1336003870
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN SAGE
Provider Business Mailing Address
First Line : 1759 W YOUNGS DITCH RD
Second Line :
City : BAY CITY
State : MI
Zip : 48708-9173
Country : US
Telephone Number : 989-209-3250
Fax Number :
Provider Business Practice Location Address
First Line : 1759 W YOUNGS DITCH RD
Second Line :
City : BAY CITY
State : MI
Zip : 48708-9173
Country : US
Telephone Number : 989-209-3250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 03/17/2026

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Directions to “ ETHAN SAGE ” Practice Location

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