Healthcare Provider Details

I. General information

NPI: 1518466457
Provider Name (Legal Business Name): EMILY MARIE HOFFMAN M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MARIE CORLESS M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PARKWAY SUITE 163
NOVI MI
48374
US

IV. Provider business mailing address

26850 PROVIDENCE PARKWAY SUITE 163
NOVI MI
48374
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4190
  • Fax:
Mailing address:
  • Phone: 248-227-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005244
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: