Provider Demographics
NPI:1154819928
Name:SELLEN, SARAH MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:SELLEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:CORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:101 11TH AVE S STE 155
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 11TH AVE S STE 155
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3918
Practice Address - Country:US
Practice Address - Phone:208-466-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist