Active NPI
Fidela Bouathong
- Speech-Language Pathologist
- Sacramento, CA
National Provider Identifier
1073155206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 500 Jessie Ave
Sacramento, CA 95838-2609 - Phone
- (916) 922-7177
- NPI assigned
- Oct 9, 2019
- 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 | Primary |
Addresses
Primary practice location
500 Jessie Ave
Sacramento, CA 95838-2609
Mailing address
623 14TH St
Sacramento, CA 95814
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570579200000",
"number": "1073155206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 14TH ST",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 JESSIE AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958382609",
"telephone_number": "916-922-7177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUATHONG",
"first_name": "FIDELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-09",
"last_updated": "2019-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.