Provider Demographics
NPI:1083850887
Name:HOMISHAK, SHERI (OD, BCBA)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:HOMISHAK
Suffix:
Gender:F
Credentials:OD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 TARTAGLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-3071
Mailing Address - Country:US
Mailing Address - Phone:501-762-9027
Mailing Address - Fax:
Practice Address - Street 1:410 N ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-4107
Practice Address - Country:US
Practice Address - Phone:501-762-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-08-4379103K00000X
TX2239103K00000X
AR1-08-4379103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst