Provider Demographics
NPI:1427573419
Name:WISLOCKI, SARAH (BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WISLOCKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4631
Mailing Address - Country:US
Mailing Address - Phone:203-554-0763
Mailing Address - Fax:203-306-3219
Practice Address - Street 1:1 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4631
Practice Address - Country:US
Practice Address - Phone:203-554-0763
Practice Address - Fax:203-306-3219
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst