Healthcare Provider Details

I. General information

NPI: 1003162629
Provider Name (Legal Business Name): NOEL Q. HURST MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N CRESTMONT DR
MERIDIAN ID
83642-2184
US

IV. Provider business mailing address

1550 N CRESTMONT DR
MERIDIAN ID
83642-2184
US

V. Phone/Fax

Practice location:
  • Phone: 208-898-0988
  • Fax:
Mailing address:
  • Phone: 208-898-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-1859
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: