Provider Demographics
NPI:1134438351
Name:HONSTETTER, TARA (MS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HONSTETTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:HONSTETTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
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:208-240-4155
Practice Address - Fax:208-470-8733
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist