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General NPI Number Information
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NPI Number | 1730029349
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Entity Type | Individual
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Provider Name | TEDI HERNANDEZ B.S., CPSS, CFSP
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Gender | Female
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 8675 W ARDENE ST
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City | BOISE
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State | ID
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Zip | 83709-2601
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Country | US
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Telephone | 208-780-3900
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Fax | 208-375-2882
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Provider Business Mailing Address
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Address Line | 10870 W TAHITI ST
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City | BOISE
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State | ID
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Zip | 83713-5162
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Country | US
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Telephone | 208-371-0215
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Fax | 208-375-2882
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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