Provider Demographics
NPI:1992250393
Name:HEDLEY, ANDREW (HIS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HEDLEY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4877 W PHILOMENA ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4657
Mailing Address - Country:US
Mailing Address - Phone:208-697-0655
Mailing Address - Fax:732-568-7915
Practice Address - Street 1:4877 W PHILOMENA ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4657
Practice Address - Country:US
Practice Address - Phone:208-697-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA2172237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist