1538882592 NPI number — MRS. SARA RAELI PRESCOTT M.S., CF-SLP

Table of content: MRS. SARA RAELI PRESCOTT M.S., CF-SLP (NPI 1538882592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538882592 NPI number — MRS. SARA RAELI PRESCOTT M.S., CF-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESCOTT
Provider First Name:
SARA
Provider Middle Name:
RAELI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CF-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRESCOTT
Provider Other First Name:
RAELI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CF-SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538882592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 MAIN ST N
Provider Second Line Business Mailing Address:
UNIT 182
Provider Business Mailing Address City Name:
KIMBERLY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83341-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-904-3500
Provider Business Mailing Address Fax Number:
208-268-3878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 MAIN ST N
Provider Second Line Business Practice Location Address:
UNIT 182
Provider Business Practice Location Address City Name:
KIMBERLY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83341-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-904-3500
Provider Business Practice Location Address Fax Number:
208-268-3878
Provider Enumeration Date:
09/23/2022

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: 235Z00000X , with the licence number:  TSLP-5465 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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