Provider Demographics
NPI:1487181632
Name:STAUFFER, KRISTIAN LAMAR (HA-2752 NBC #8040)
Entity Type:Individual
Prefix:MR
First Name:KRISTIAN
Middle Name:LAMAR
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:HA-2752 NBC #8040
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4438
Mailing Address - Country:US
Mailing Address - Phone:208-853-2650
Mailing Address - Fax:208-853-7333
Practice Address - Street 1:4121 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-4438
Practice Address - Country:US
Practice Address - Phone:208-853-2650
Practice Address - Fax:208-853-7333
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-2752237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter