Active NPI
Correne Fabanich, MS
- Speech-Language Pathologist
- Rexburg, ID
National Provider Identifier
1154847606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- TSLP-3260
- Practice address
- 36 Professional PLZ Ste 110
Rexburg, ID 83440-2049 - Phone
- (208) 359-9570
- Fax
- (208) 359-9580
- NPI assigned
- Aug 16, 2017
- 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-3260 | ID | Primary |
Addresses
Primary practice location
36 Professional PLZ Ste 110
Rexburg, ID 83440-2049
Mailing address
36 Professional PLZ Ste 110
Rexburg, ID 83440-2049
Phone (208) 359-9570
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TSLP-3260 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502841600000",
"number": "1154847606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 PROFESSIONAL PLZ STE 110",
"city": "REXBURG",
"state": "ID",
"postal_code": "834402049",
"telephone_number": "208-359-9570",
"fax_number": "208-359-9580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 PROFESSIONAL PLZ STE 110",
"city": "REXBURG",
"state": "ID",
"postal_code": "834402049",
"telephone_number": "208-359-9570",
"fax_number": "208-359-9580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FABANICH",
"first_name": "CORRENE",
"name_prefix": "Mrs.",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-16",
"last_updated": "2017-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "TSLP-3260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.