Healthcare Provider Details

I. General information

NPI: 1275248312
Provider Name (Legal Business Name): MRS. LESLIE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WASHINGTON ST
HART MI
49420-1127
US

IV. Provider business mailing address

917 W NORTON AVE
NORTON SHORES MI
49441-4105
US

V. Phone/Fax

Practice location:
  • Phone: 231-670-6480
  • Fax:
Mailing address:
  • Phone: 231-728-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: