Provider Demographics
NPI:1295439800
Name:SMITH, SARAH ANN (RBT)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E GRAND AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1839
Mailing Address - Country:US
Mailing Address - Phone:641-660-9703
Mailing Address - Fax:
Practice Address - Street 1:2825 S ANKENY BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9417
Practice Address - Country:US
Practice Address - Phone:515-598-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician