Provider Demographics
NPI:1033765862
Name:SAUNDERS, TAMI J
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:J
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-5077
Mailing Address - Country:US
Mailing Address - Phone:208-716-5031
Mailing Address - Fax:
Practice Address - Street 1:242 E 7TH N STE 4
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3550
Practice Address - Country:US
Practice Address - Phone:208-359-9683
Practice Address - Fax:208-359-0889
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1639292626Medicaid