Provider Demographics
NPI:1134277429
Name:FUGLEBERG, SARAH M
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:M
Last Name:FUGLEBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12499 UNIVERSITY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8281
Mailing Address - Country:US
Mailing Address - Phone:515-418-9960
Mailing Address - Fax:515-418-9107
Practice Address - Street 1:12499 UNIVERSITY AVE
Practice Address - Street 2:STE 200
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8281
Practice Address - Country:US
Practice Address - Phone:515-418-9960
Practice Address - Fax:515-418-9107
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE254231H00000X
NE081237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4723312Medicaid
IA1723312Medicaid
NE100250037-00Medicaid
NE100250041-00Medicaid
NE100252023-00Medicaid
IA7723312Medicaid
NE36845OtherBCBS
NE100251703-00Medicaid
NE100252024-00Medicaid
NE10025369300Medicaid
IA5723312Medicaid
IA6723312Medicaid
NE10025369400Medicaid
NE100251704-00Medicaid
NE099747004Medicare PIN