Healthcare Provider Details

I. General information

NPI: 1659723294
Provider Name (Legal Business Name): MS. TIFFANY HOAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 E BUTTERFIELD RD STE 310-01
LOMBARD IL
60148-5618
US

IV. Provider business mailing address

477 E BUTTERFIELD RD STE 310-01
LOMBARD IL
60148-5618
US

V. Phone/Fax

Practice location:
  • Phone: 630-217-5738
  • Fax:
Mailing address:
  • Phone: 630-217-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: