Basic Information
| Provider Information | |||||||||
| NPI: | 1205148475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANKOVICH | ||||||||
| FirstName: | LENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10549 BARDILINO ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891414252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026170071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3027 E SUNSET RD | ||||||||
| Address2: | SUITE #108 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891202731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022703219 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2010 | ||||||||
| LastUpdateDate: | 07/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-10-6747 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.