Unknown Individual – Speech-Language Pathologist, NPI 1518375005

Speech-Language Pathologist

Unknown Individual is a healthcare provider. based in Kuna, Idaho. specializing in Speech-Language Pathologist. They hold a License No. TSLP - 2494 (ID). The NPI Number for Unknown Individual is 1518375005

Main info

Organization

Inactive

13 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1518375005

Phone

(208) 585-8314

Address

12790 S SONORA AVE

Deactivation Date

25 November 2020

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7192296596

Graduation Year

2013 (13 years ago)

PAC ID

1557613627

Group Practice PAC ID

6204163462

Professional Enrollment ID

I20181018000409

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

12790 S SONORA AVE
KUNA, ID 836342658
Phone: (208) 585-8314
Fax: (208) 323-8889
Type: Mailing
6855 W FAIRVIEW AVE
BOISE, ID 837048046
Phone: (208) 323-8888
Fax: (208) 323-8889
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 83634)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 6204163462View full group profile