Healthcare Provider Details

I. General information

NPI: 1801220314
Provider Name (Legal Business Name): JESSICA STACY HOEFLER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 01/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 YORK AVE SUITE 1
BOARDMAN OH
44512-5615
US

IV. Provider business mailing address

126 YORK AVE SUITE 1
BOARDMAN OH
44512-5615
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-3339
  • Fax: 330-726-0482
Mailing address:
  • Phone: 330-726-3339
  • Fax: 330-726-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.01871
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: