Provider Demographics
NPI: | 1437859170 |
---|---|
Name: | HONSTETTER ENTERPRISES, INC |
Entity Type: | Organization |
Organization Name: | HONSTETTER ENTERPRISES, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HONSTETTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, CCC-SLP |
Authorized Official - Phone: | 208-240-4155 |
Mailing Address - Street 1: | 3050 N LAKEHARBOR LN STE 214 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOISE |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83703-6243 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-240-4155 |
Mailing Address - Fax: | 208-470-8733 |
Practice Address - Street 1: | 3050 N LAKEHARBOR LN STE 214 |
Practice Address - Street 2: | |
Practice Address - City: | BOISE |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83703-6243 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-254-0441 |
Practice Address - Fax: | 208-470-8733 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-03-09 |
Last Update Date: | 2023-03-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |