Healthcare Provider Details

I. General information

NPI: 1497930762
Provider Name (Legal Business Name): LYNDI SUE HOFSTRA BS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12705 S RIDGELAND AVE HOFSTRA FAMILY HEARING
PALOS HEIGHTS IL
60463
US

IV. Provider business mailing address

12705 SO RIDGELAND AVE HOFSTRA FAMILY HEARING
PALOS HEIGHTS IL
60463
US

V. Phone/Fax

Practice location:
  • Phone: 708-385-9402
  • Fax: 708-385-9403
Mailing address:
  • Phone: 708-385-9402
  • Fax: 708-385-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2898
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: