Provider Demographics
NPI:1306135900
Name:LOLLI-SUNDERLIN, YRENKA (BCBA)
Entity type:Individual
Prefix:
First Name:YRENKA
Middle Name:
Last Name:LOLLI-SUNDERLIN
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 1:3113 W ROSE HILL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1651
Mailing Address - Country:US
Mailing Address - Phone:208-297-1405
Mailing Address - Fax:805-823-4462
Practice Address - Street 1:3113 W ROSE HILL ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1651
Practice Address - Country:US
Practice Address - Phone:208-297-1405
Practice Address - Fax:805-823-4462
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDDA-6253251C00000X
CA1-10-6753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251C00000XAgenciesDay Training, Developmentally Disabled Services