Provider Demographics
NPI:1235789769
Name:LAYMAN, SARAH (BS, BIS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LAYMAN
Suffix:
Gender:F
Credentials:BS, BIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 N NUGGET LN
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8486
Mailing Address - Country:US
Mailing Address - Phone:208-507-1324
Mailing Address - Fax:
Practice Address - Street 1:2650 N NUGGET LN
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8486
Practice Address - Country:US
Practice Address - Phone:208-507-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0003928Medicaid