Provider Demographics
NPI:1760895270
Name:WESTERN, BENJAMIN (HID)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WESTERN
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 E 25TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4725
Mailing Address - Country:US
Mailing Address - Phone:208-403-2832
Mailing Address - Fax:
Practice Address - Street 1:2285 E 25TH ST STE 201
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4725
Practice Address - Country:US
Practice Address - Phone:208-403-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-2764237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist