Provider Demographics
NPI:1902213945
Name:MOOSEAU, SARAH JEAN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEAN
Last Name:MOOSEAU
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:LINDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 N. 2ND STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-385-3440
Mailing Address - Fax:208-385-3441
Practice Address - Street 1:510 N. 2ND STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-385-3440
Practice Address - Fax:208-385-3441
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
IDAUD-3011231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter