Healthcare Provider Details

I. General information

NPI: 1245976869
Provider Name (Legal Business Name): SLOANE BOOTERBAUGH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-1234
  • Fax: 509-575-3320
Mailing address:
  • Phone: 509-865-2395
  • Fax: 509-865-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO.OP.70145803
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: