Healthcare Provider Details

I. General information

NPI: 1063904597
Provider Name (Legal Business Name): MS. SHERRICE A HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 162ND ST
SOUTH HOLLAND IL
60473-2236
US

IV. Provider business mailing address

29 WEST 124TH STREET
CHICAGO IL
60628
US

V. Phone/Fax

Practice location:
  • Phone: 773-819-5504
  • Fax:
Mailing address:
  • Phone: 773-458-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: