Healthcare Provider Details

I. General information

NPI: 1023190790
Provider Name (Legal Business Name): DANA BETH HOFSTETTER LSW, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 LOCUST ST
VALPARAISO IN
46383-5441
US

IV. Provider business mailing address

253 E 500 S
VALPARAISO IN
46383-7859
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-3919
  • Fax:
Mailing address:
  • Phone: 630-561-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33005166A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: