Healthcare Provider Details

I. General information

NPI: 1013845981
Provider Name (Legal Business Name): RACHEL HART WARDROP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 W BRIDGER BAY DR
STAR ID
83669-5081
US

IV. Provider business mailing address

846 S STAR RD STE 201
STAR ID
83669-6458
US

V. Phone/Fax

Practice location:
  • Phone: 208-391-2773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5881208
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: