Healthcare Provider Details

I. General information

NPI: 1902213945
Provider Name (Legal Business Name): SARAH JEAN MOOSEAU AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JEAN LINDBERG

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N. 2ND STREET SUITE 201
BOISE ID
83702
US

IV. Provider business mailing address

510 N. 2ND STREET SUITE 201
BOISE ID
83702
US

V. Phone/Fax

Practice location:
  • Phone: 208-385-3440
  • Fax: 208-385-3441
Mailing address:
  • Phone: 208-385-3440
  • Fax: 208-385-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-3011
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: