MEDICARE: MS. SARAH PANTING M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-2973	ID

General Provider Information

NPI Number	:	1801243506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH PANTING M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	369 W 1ST N
Second Line	:
City	:	REXBURG
State	:	ID
Zip	:	83440-1403
Country	:	US
Telephone Number	:	208-351-3695
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 S YELLOWSTONE HWY
Second Line	:	SUITE 1701
City	:	REXBURG
State	:	ID
Zip	:	83440-5293
Country	:	US
Telephone Number	:	208-351-3695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	05/23/2016

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Directions to “ MS. SARAH PANTING M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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