Provider Demographics
NPI:1841091295
Name:BRANSTETTER, HEATHER LEE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:BRANSTETTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:ID
Mailing Address - Zip Code:83873-2133
Mailing Address - Country:US
Mailing Address - Phone:208-230-8454
Mailing Address - Fax:
Practice Address - Street 1:620 E MULLAN AVE
Practice Address - Street 2:
Practice Address - City:OSBURN
Practice Address - State:ID
Practice Address - Zip Code:83849-0480
Practice Address - Country:US
Practice Address - Phone:208-261-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3371056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional