Healthcare Provider Details

I. General information

NPI: 1033901699
Provider Name (Legal Business Name): HEATHER HOSTLER PPS, ESA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER FEDERMEYER NCSP, MESP

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13258 ALLISON RANCH RD
GRASS VALLEY CA
95949-9404
US

IV. Provider business mailing address

13258 ALLISON RANCH RD
GRASS VALLEY CA
95949-9404
US

V. Phone/Fax

Practice location:
  • Phone: 530-559-6650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: