Healthcare Provider Details

I. General information

NPI: 1528404050
Provider Name (Legal Business Name): JENNA LEE HOFFMAN MSW, LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 S VAN DYKE RD
BAD AXE MI
48413-9615
US

IV. Provider business mailing address

1108 S VAN DYKE RD
BAD AXE MI
48413-9615
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9293
  • Fax: 989-269-7544
Mailing address:
  • Phone: 989-269-9293
  • Fax: 989-269-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801094996
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: