MEDICARE: SARAH MCDERMOTT

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1023650538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MCDERMOTT

Provider Business Mailing Address
First Line	:	733 N MAIN ST STE C
Second Line	:
City	:	BELLEVUE
State	:	ID
Zip	:	83313-6068
Country	:	US
Telephone Number	:	208-788-0146
Fax Number	:

Provider Business Practice Location Address
First Line	:	733 N MAIN ST STE C
Second Line	:
City	:	BELLEVUE
State	:	ID
Zip	:	83313-6068
Country	:	US
Telephone Number	:	208-788-0146
Fax Number	:

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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Directions to “ SARAH MCDERMOTT ” Practice Location

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