Healthcare Provider Details

I. General information

NPI: 1659464238
Provider Name (Legal Business Name): KENNETH LEE HOFFMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S BRIDGE ST STE C
GRAND LEDGE MI
48837-1587
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 810-772-4351
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301011111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: