MEDICARE: DR. SARA BRYN MORROW PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY202225	ID

General Provider Information

NPI Number	:	1891704318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA BRYN MORROW PH.D.

Provider Business Mailing Address
First Line	:	10658 N OAK ST
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-9408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7905 N MEADOWLARK WAY STE E
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-5041
Country	:	US
Telephone Number	:	208-651-2412
Fax Number	:	208-765-8608

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/18/2016

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