Provider Demographics
NPI:1992332688
Name:STAUFFER, KHAYMAN
Entity type:Individual
Prefix:
First Name:KHAYMAN
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9718 W TOUCHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6973
Mailing Address - Country:US
Mailing Address - Phone:208-509-5836
Mailing Address - Fax:
Practice Address - Street 1:4696 W OVERLAND RD STE 216
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2864
Practice Address - Country:US
Practice Address - Phone:208-713-5004
Practice Address - Fax:208-327-9828
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-4058237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist