Provider Demographics
NPI:1427475003
Name:BUNNEY, SABRINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:BUNNEY
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 1:1057 STRIPES RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1985
Mailing Address - Country:US
Mailing Address - Phone:208-406-7733
Mailing Address - Fax:
Practice Address - Street 1:1057 STRIPES RD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1985
Practice Address - Country:US
Practice Address - Phone:208-406-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist