Healthcare Provider Details

I. General information

NPI: 1689231375
Provider Name (Legal Business Name): JENNIFER HOFELICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S SHERRIN AVE STE 230
LOUISVILLE KY
40207-3237
US

IV. Provider business mailing address

119 S SHERRIN AVE STE 230
LOUISVILLE KY
40207-3237
US

V. Phone/Fax

Practice location:
  • Phone: 502-224-9176
  • Fax:
Mailing address:
  • Phone: 502-224-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number254046
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: