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NPI Code Detail

MEDICARE: SARAH CLEMENS

MEDICARE: SARAH CLEMENS
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
2103K00000XBehavior Analyst1-19-39698MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548711658
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH CLEMENS
Provider Business Mailing Address
First Line : 658 NORTHRUP AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4704
Country : US
Telephone Number : 810-358-3038
Fax Number :
Provider Business Practice Location Address
First Line : 4234 CASCADE RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8384
Country : US
Telephone Number : 616-942-5570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2016
Last Update Date : 04/18/2022

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