Active NPI
Rebecca Renee Fish
- Speech-Language Pathologist
- Caldwell, ID
National Provider Identifier
1336429653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- TSLP-2124
- Practice address
- 15081 Widgeon Ave
Caldwell, ID 83607-8383 - Phone
- (208) 880-3080
- Fax
- (208) 454-9003
- NPI assigned
- Aug 17, 2011
- Last updated
- Jun 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
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-2124 | ID | Primary |
Addresses
Primary practice location
15081 Widgeon Ave
Caldwell, ID 83607-8383
Mailing address
15081 Widgeon Ave
Caldwell, ID 83607-8383
Phone (208) 880-3080
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-2124 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686700800000",
"number": "1336429653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15081 WIDGEON AVE",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836078383",
"telephone_number": "208-880-3080",
"fax_number": "208-454-9003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15081 WIDGEON AVE",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836078383",
"telephone_number": "208-880-3080",
"fax_number": "208-454-9003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISH",
"first_name": "REBECCA",
"middle_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-17",
"last_updated": "2023-06-14",
"certification_date": "2023-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "TSLP-2124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.