Healthcare Provider Details

I. General information

NPI: 1063425692
Provider Name (Legal Business Name): JODY R HOFFMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/27/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WASHINGTON ST STE 410
ANN ARBOR MI
48104-2017
US

IV. Provider business mailing address

202 E WASHINGTON ST STE 410
ANN ARBOR MI
48104-2017
US

V. Phone/Fax

Practice location:
  • Phone: 734-660-9776
  • Fax:
Mailing address:
  • Phone: 734-660-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012389
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: