Healthcare Provider Details

I. General information

NPI: 1780417345
Provider Name (Legal Business Name): KILEY HOFFMAN M.S., SLP-CF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PORTER DR STE 120
SAN RAMON CA
94583-1525
US

IV. Provider business mailing address

210 PORTER DR STE 120
SAN RAMON CA
94583-1525
US

V. Phone/Fax

Practice location:
  • Phone: 510-504-3034
  • Fax:
Mailing address:
  • Phone: 510-504-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: