1902925712 NPI number — SARA ANNE BIGELOW LCPC

Table of content: SARA ANNE BIGELOW LCPC (NPI 1902925712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902925712 NPI number — SARA ANNE BIGELOW LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIGELOW
Provider First Name:
SARA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUILAR
Provider Other First Name:
SARA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902925712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 E CENTER ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-5737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-251-0226
Provider Business Mailing Address Fax Number:
208-251-3282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 E CENTER ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-5737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-251-0226
Provider Business Practice Location Address Fax Number:
208-251-3282
Provider Enumeration Date:
03/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LCPC-3931 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: LPC-3425 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)