Provider Demographics
NPI:1811323579
Name:HULSIZER, SARA JACOBSEN (SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JACOBSEN
Last Name:HULSIZER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:JACOBSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7211 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0926
Mailing Address - Country:US
Mailing Address - Phone:208-569-5433
Mailing Address - Fax:
Practice Address - Street 1:7211 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0926
Practice Address - Country:US
Practice Address - Phone:208-569-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP2859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist