Provider Demographics
NPI:1750828448
Name:CORWIN, SARAH ANN (BCBA)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ANN
Last Name:CORWIN
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 1:504 LIONS DR
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9788
Mailing Address - Country:US
Mailing Address - Phone:816-345-5821
Mailing Address - Fax:
Practice Address - Street 1:1114 REMINGTON PLZ
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8584
Practice Address - Country:US
Practice Address - Phone:816-730-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 106S00000X
MO1-24-75355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst