Provider Demographics
NPI:1609156793
Name:BERGSMA, SARA NICHOLE (MS SLP CCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:NICHOLE
Last Name:BERGSMA
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10873 W SENECA DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3946
Mailing Address - Country:US
Mailing Address - Phone:208-514-5660
Mailing Address - Fax:208-467-2201
Practice Address - Street 1:10873 W SENECA DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3946
Practice Address - Country:US
Practice Address - Phone:208-514-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist