Doctor Name: | SARA NICHOLE BERGSMA |
NPI Number: | 1609156793 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS SLP CCC |
License Number: | SLP-2264 |
Business Practice Address: | 168 Mcclure Ave Nampa, ID - 836512025 |
Business Phone Number: | 2084661077 |
Business Fax Number: | 2084672201 |
Mailing Address: | 168 Mcclure Ave, NAMPA |
State: | ID |
Postal Code: | 836512025 |
Phone Number: | 2084661077 |
Fax Number: | 2084672201 |
NPI Enumeration Date: | 08/22/2011 |
NPI Last Update Date: | 07/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP-2264 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |