Healthcare Provider Details

I. General information

NPI: 1750654596
Provider Name (Legal Business Name): IAN E HOFFMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 S 75TH AVE FL 3
PALOS HEIGHTS IL
60463-1033
US

IV. Provider business mailing address

281 W WASHINGTON ST
OSWEGO IL
60543-9817
US

V. Phone/Fax

Practice location:
  • Phone: 708-671-8440
  • Fax: 630-859-2994
Mailing address:
  • Phone: 320-260-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010364
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: