Provider Demographics
NPI:1497538110
Name:HOSTETLER, ALISYN NICOLE
Entity Type:Individual
Prefix:
First Name:ALISYN
Middle Name:NICOLE
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1244
Mailing Address - Country:US
Mailing Address - Phone:765-698-4341
Mailing Address - Fax:
Practice Address - Street 1:316 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-1244
Practice Address - Country:US
Practice Address - Phone:765-698-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician