Healthcare Provider Details

I. General information

NPI: 1144682808
Provider Name (Legal Business Name): MIRANDA G HOFFMANN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N WALNUT ST
CHAMPAIGN IL
61820-3055
US

IV. Provider business mailing address

403 CARRIE AVE
URBANA IL
61802-2103
US

V. Phone/Fax

Practice location:
  • Phone: 217-693-4578
  • Fax:
Mailing address:
  • Phone: 217-414-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: