Provider Demographics
NPI:1265881601
Name:DESIMONE, SARAH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 E TELLUM AVE
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-9293
Mailing Address - Country:US
Mailing Address - Phone:208-994-3757
Mailing Address - Fax:
Practice Address - Street 1:6101 E HIGHWAY 54 STE A
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-6085
Practice Address - Country:US
Practice Address - Phone:208-994-3757
Practice Address - Fax:208-352-3921
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60758918235Z00000X
IDSLP-4509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist