Most Relevant Information
Provider Data
| NPI Number: | 1003578550 |
| Provider Name: | SARAH ELLENWINE BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/12/2021 |
| Last Updated: | 10/12/2021 |
Provider Practice Location
2753 S 11TH ST
NILES
MI
491204419
Practice Location Phone/Fax
| Phone: | 2693590689 |
| Fax: | 5742042868 |
Provider Mailing Location
1824 TOUBY PIKE STE B
KOKOMO
IN
469012573
Provider Mailing Phone/Fax
| Phone: | 7656287400 |
| Fax: | 8559400177 |