Provider Demographics
NPI:1518849710
Name:CRISMAN, JONATHAN DAVID (HIS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:CRISMAN
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 1:610 W HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2285
Mailing Address - Country:US
Mailing Address - Phone:208-765-6186
Mailing Address - Fax:
Practice Address - Street 1:610 W HUBBARD AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2285
Practice Address - Country:US
Practice Address - Phone:208-765-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2771660237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist