Provider Demographics
NPI:1295530715
Name:BLACKSTEN, MORGAN (HIS)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BLACKSTEN
Suffix:
Gender:
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1826
Mailing Address - Country:US
Mailing Address - Phone:208-356-0766
Mailing Address - Fax:208-359-9488
Practice Address - Street 1:117 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1826
Practice Address - Country:US
Practice Address - Phone:208-356-0766
Practice Address - Fax:208-359-9488
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-4757237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist