Provider Demographics
NPI:1184993750
Name:IBBETSON, SARA (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:IBBETSON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 N PRINCE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2523
Mailing Address - Country:US
Mailing Address - Phone:620-230-5161
Mailing Address - Fax:
Practice Address - Street 1:526 N PRINCE LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2523
Practice Address - Country:US
Practice Address - Phone:620-230-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011004148103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst