Healthcare Provider Details

I. General information

NPI: 1780087817
Provider Name (Legal Business Name): MELISSA HOFFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 LAFAYETTE AVE SE STE 330
GRAND RAPIDS MI
49503-4677
US

IV. Provider business mailing address

360 LAFAYETTE AVE SE STE 330
GRAND RAPIDS MI
49503-4677
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8436
  • Fax: 616-840-9602
Mailing address:
  • Phone: 616-840-8436
  • Fax: 616-840-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: