MEDICARE: SARAH JANE SIMON

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
1	103K00000X	Behavior Analyst	1203-140	WI

General Provider Information

NPI Number	:	1699439323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JANE SIMON

Provider Business Mailing Address
First Line	:	2306 MICA RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-4636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4232 LONDON ROAD
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-2728
Country	:	US
Telephone Number	:	920-857-9041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	06/13/2024

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Directions to “ SARAH JANE SIMON ” Practice Location

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