Provider Demographics
NPI:1437613148
Name:PERRIN, SADIE RAE (BCBA)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:RAE
Last Name:PERRIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:RAE
Other - Last Name:PREJEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 N SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4383
Mailing Address - Country:US
Mailing Address - Phone:479-890-5494
Mailing Address - Fax:
Practice Address - Street 1:301 N SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4383
Practice Address - Country:US
Practice Address - Phone:479-890-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-21-54853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst