Provider Demographics
NPI:1821229733
Name:DUNKEL-JACKSON, SARAH M (MS, BCBA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:M
Last Name:DUNKEL-JACKSON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:DUNKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-824-9219
Practice Address - Street 1:8542 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2326
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-08-4630103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst