NPIMap

Organization Active NPI

Star Speech and Occupational Therapy LLC

  • Speech-Language Pathologist
  • Star, ID
National Provider Identifier
1669917571
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP2395 Issued in ID
Legal business name
STAR SPEECH AND OCCUPATIONAL THERAPY LLC
Practice address
12222 W Bridger Bay Dr
Star, ID 83669-5081
Phone
(208) 391-2773
Fax
(855) 255-0774
NPI assigned
Dec 31, 2016
Last updated
May 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Meara Baker, MA, CCC-SLPNPI 1518032853
Title
Owner, Speech-Langauge Pathologist
Phone
(208) 391-2773

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: 193400000X SINGLE SPECIALTY GROUP 235Z00000X SLP2395 ID Primary

Addresses

Primary practice location

12222 W Bridger Bay Dr
Star, ID 83669-5081

Mailing address

12124 W Feramorz LN
Star, ID 83669-5165
Phone (208) 391-2773

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200330002981 ID Part B Supplier - Clinic/Group Practice 5991134793 Receives reassigned benefits from 3 practitioners
Practice locations: Star, ID

National Provider Directory

National Provider Directory

Locations

12222 W Bridger Bay Dr
Star, ID 83669
Phone (208) 391-2773

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1483142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1669917571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12124 W FERAMORZ LN",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695165",
            "telephone_number": "208-391-2773",
            "fax_number": "855-255-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12222 W BRIDGER BAY DR",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695081",
            "telephone_number": "208-391-2773",
            "fax_number": "855-255-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR SPEECH AND OCCUPATIONAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-31",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "MEARA",
        "authorized_official_title_or_position": "OWNER, SPEECH-LANGAUGE PATHOLOGIST",
        "authorized_official_telephone_number": "208-391-2773",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP2395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Star, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.