Healthcare Provider Details

I. General information

NPI: 1366844276
Provider Name (Legal Business Name): HAYLIE HOFFMAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 HIGHWAY 107
SHERWOOD AR
72120-5200
US

IV. Provider business mailing address

3601 RICHARDS RD
NORTH LITTLE ROCK AR
72117-2954
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-4174
  • Fax:
Mailing address:
  • Phone: 501-221-1843
  • Fax: 501-221-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA1802010
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: