Healthcare Provider Details

I. General information

NPI: 1023620655
Provider Name (Legal Business Name): MR. JASON HOFFMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5952 N PAULINA ST APT 2S
CHICAGO IL
60660-3261
US

IV. Provider business mailing address

5952 N PAULINA ST APT 2S
CHICAGO IL
60660-3261
US

V. Phone/Fax

Practice location:
  • Phone: 773-710-3883
  • Fax:
Mailing address:
  • Phone: 773-710-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026497
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: