Provider Demographics
NPI:1780867838
Name:COFFRIN, SARAH (ST)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:COFFRIN
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:RONGSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1080235Z00000X
MT5777235Z00000X
MT1156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000663230OtherBCBS PIN
ND55548Medicaid
ND714676Medicare PIN
MT1153260003Medicare PIN