Provider Demographics
NPI:1225543150
Name:KOROMA, NEHEMIAH SAHR (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:
First Name:NEHEMIAH
Middle Name:SAHR
Last Name:KOROMA
Suffix:
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5374 EASTERN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2720
Mailing Address - Country:US
Mailing Address - Phone:920-857-9041
Mailing Address - Fax:
Practice Address - Street 1:5374 EASTERN AVE STE 600
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2720
Practice Address - Country:US
Practice Address - Phone:920-857-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105824103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARBT-17-39093OtherREGISTER BEHAVIOR TECHNICIAN