Provider Demographics
NPI:1619662988
Name:HOVDESTAD, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HOVDESTAD
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 1:17913 LOS PRADOS ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6019
Mailing Address - Country:US
Mailing Address - Phone:714-683-3250
Mailing Address - Fax:
Practice Address - Street 1:17913 LOS PRADOS ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6019
Practice Address - Country:US
Practice Address - Phone:714-683-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician