Provider Demographics
NPI:1326554023
Name:THOMSEN, SARA (BCABA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 S 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2813
Mailing Address - Country:US
Mailing Address - Phone:402-812-5939
Mailing Address - Fax:402-891-8860
Practice Address - Street 1:6424 S 150TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3916
Practice Address - Country:US
Practice Address - Phone:402-812-5939
Practice Address - Fax:402-891-8860
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17-38581106S00000X
0-21-12890106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-21-12890OtherBACB