Active NPI
Kimberly Degraw
- Speech-Language Pathologist
- Boise, ID
National Provider Identifier
1033698303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- TSLP-4912
- Practice address
- 901 N Curtis Rd Ste 204
Boise, ID 83706-1340 - Phone
- (208) 367-8282
- NPI assigned
- Aug 8, 2018
- Last updated
- Sep 14, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | TSLP-4912 | ID | Primary |
Addresses
Primary practice location
901 N Curtis Rd Ste 204
Boise, ID 83706-1340
Mailing address
1409 E Cougar Creek Dr
Meridian, ID 83646-7809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TSLP-4912 | ID | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern New Mexico University | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba ENMU Speech Hearing Outreach Rehabilitation Center
- Speech-Language Pathologist
- Portales, NM
- NPI 1356115273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631577600000",
"number": "1033698303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1409 E COUGAR CREEK DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836467809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 N CURTIS RD STE 204",
"city": "BOISE",
"state": "ID",
"postal_code": "837061340",
"telephone_number": "208-367-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEGRAW",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-08",
"last_updated": "2021-09-14",
"certification_date": "2021-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "TSLP-4912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.