Healthcare Provider Details

I. General information

NPI: 1144397001
Provider Name (Legal Business Name): KELLY GRAHAM HOFFMANN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E NORTHWEST HWY STE 206
MOUNT PROSPECT IL
60056-3457
US

IV. Provider business mailing address

6055 N FOREST GLEN AVE
CHICAGO IL
60646-5013
US

V. Phone/Fax

Practice location:
  • Phone: 847-696-1100
  • Fax:
Mailing address:
  • Phone: 312-339-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number71006989
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: