Doctor Name: | TARA HONSTETTER |
NPI Number: | 1134438351 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S |
License Number: | |
Business Practice Address: | 4650 Hawthorne Rd Ste 3b Chubbuck, ID - 832022376 |
Business Phone Number: | 2082379833 |
Business Fax Number: | |
Mailing Address: | 4650 Hawthorne Rd, Ste 3b CHUBBUCK |
State: | ID |
Postal Code: | 832022376 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/05/2010 |
NPI Last Update Date: | 10/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |