Healthcare Provider Details

I. General information

NPI: 1457002131
Provider Name (Legal Business Name): RENAE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 N OAK ST
COLUMBIA CITY IN
46725-1608
US

IV. Provider business mailing address

6030 W STATE ROAD 205
SOUTH WHITLEY IN
46787-9130
US

V. Phone/Fax

Practice location:
  • Phone: 260-244-0264
  • Fax:
Mailing address:
  • Phone: 260-609-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: