Provider Demographics
NPI:1619559333
Name:RUSSELL, SARAH ANNE (MED, QASP-S, QBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MED, QASP-S, QBA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7011 CAMPUS DR STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1355 GARDEN OF THE GODS RD STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3595
Practice Address - Country:US
Practice Address - Phone:719-212-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12290106E00000X
106S00000X
CO14035103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician