Provider Demographics
NPI:1861170490
Name:HORTENSTINE, JAMES DOUGLAS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS
Last Name:HORTENSTINE
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 1:2 COPPERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3600
Mailing Address - Country:US
Mailing Address - Phone:217-246-9985
Mailing Address - Fax:
Practice Address - Street 1:300 S SCOTT AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1658
Practice Address - Country:US
Practice Address - Phone:618-783-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist