Provider Demographics
NPI:1891501094
Name:YEAZLE, SABRENA (BCBA)
Entity type:Individual
Prefix:
First Name:SABRENA
Middle Name:
Last Name:YEAZLE
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 1:118 AN SEAN MHUILEANN, NORTH CIRCULAR RD
Mailing Address - Street 2:
Mailing Address - City:TRALEE COUNTY KERRY
Mailing Address - State:ZZ - FOREIGN COUNTRIES
Mailing Address - Zip Code:V92 A094
Mailing Address - Country:IE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2905 NORTHWEST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2605
Practice Address - Country:US
Practice Address - Phone:612-355-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst