NPIMap

Organization Active NPI

Idaho Speech & Swallow Services

  • Speech-Language Pathologist
  • Boise, ID
National Provider Identifier
1104416288
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
IDAHO SPEECH & SWALLOW SERVICES
Practice address
4696 W Overland Rd Ste 232
Boise, ID 83705-2864
Phone
(208) 996-0828
NPI assigned
Jan 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Camarin Lawlor, M.S., CCC-SLPNPI 1548635436
Title
Owner/Speech-Language Pathologist
Phone
(619) 228-6060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

4696 W Overland Rd Ste 232
Boise, ID 83705-2864

Mailing address

4696 W Overland Rd Ste 232
Boise, ID 83705-2864
Phone (208) 996-0828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210526001019 ID Part B Supplier - Clinic/Group Practice 9739588633 Receives reassigned benefits from 3 practitioners
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

6001 W State St
Ste C
Boise, ID 83703
Phone (208) 954-1343

4696 W Overland Rd
Ste 232
Boise, ID 83705
Phone (208) 908-6116

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1104416288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4696 W OVERLAND RD STE 232",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052864",
            "telephone_number": "208-996-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4696 W OVERLAND RD STE 232",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052864",
            "telephone_number": "208-996-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO SPEECH & SWALLOW SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "LAWLOR",
        "authorized_official_first_name": "CAMARIN",
        "authorized_official_title_or_position": "OWNER/SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "619-228-6060",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "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 Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.