Provider Demographics
NPI:1114400355
Name:AVENDANO, SARAH M (BCBA, MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:AVENDANO
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA, MA
Mailing Address - Street 1:620 FARM LN RM 146
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4213
Practice Address - Country:US
Practice Address - Phone:517-884-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-17-27306103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst