Healthcare Provider Details

I. General information

NPI: 1164939229
Provider Name (Legal Business Name): JENNIFER ANNE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12127 93RD AVENUE CT
COAL VALLEY IL
61240-9703
US

IV. Provider business mailing address

12127 93RD AVENUE CT
COAL VALLEY IL
61240-9703
US

V. Phone/Fax

Practice location:
  • Phone: 309-721-1530
  • Fax:
Mailing address:
  • Phone: 309-721-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: