Provider Demographics
NPI:1720758485
Name:STREET, SARAH (RBT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STREET
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 1:3084 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1258
Mailing Address - Country:US
Mailing Address - Phone:765-400-4258
Mailing Address - Fax:765-398-2426
Practice Address - Street 1:3084 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1258
Practice Address - Country:US
Practice Address - Phone:765-400-4258
Practice Address - Fax:765-393-2426
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician