Fabiola Koperberg, MS

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-4727 Issued in ID

Practice address

36 Professional PLZ Ste 110
Rexburg, ID 83440-2049

Phone

(208) 734-3356

NPI assigned

May 20, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MHD Therapies, PLLC

  • Physical Therapist
  • Rexburg, ID
  • NPI 1316484983

  Speech-Language Pathologist

  NPD
• Casa Pediatric Care LLC

  • Speech-Language Pathologist
  • Springdale, AR
  • NPI 1346873007
  NPD (past)

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1417695453",
    "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"
        },
        {
            "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": "208-734-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPERBERG",
        "first_name": "FABIOLA",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-4727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "SLP-4727",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.rehabspecialistsofidaho.com",
            "affiliation": "N",
            "endpointDescription": "company webpage",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "company",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "36 Professional Plz Ste 110",
            "city": "Rexburg",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834402049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brian Kingsford, OT
• Gail Ann Kisling, M.S., CCC-SLP
• Greg Lyle Klingler, PA-C
• Jane Klingler
• Kelly Alma Klingler, DPT, PT
• Kylin Kovac DPM PLLC
• Carol Ladle, F.N.P.-C
• Aileen Lai
• Lake Thompson Counseling
• Brennen Larsen, PA-C

• Speech-Language Pathologist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.