Provider Demographics
NPI:1508457847
Name:WAYCHOFF, SARA YASMINE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:YASMINE
Last Name:WAYCHOFF
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 1:512 W F ST
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-2039
Mailing Address - Country:US
Mailing Address - Phone:720-683-1628
Mailing Address - Fax:
Practice Address - Street 1:512 W F ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2039
Practice Address - Country:US
Practice Address - Phone:720-683-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1-22-57681103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst