Healthcare Provider Details

I. General information

NPI: 1477436434
Provider Name (Legal Business Name): LATESHA HOFMANN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATESHA HAWKINS

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W MAIN ST STE 290
ARDMORE OK
73401-6330
US

IV. Provider business mailing address

2158 STOBTOWN RD
ARDMORE OK
73401-7390
US

V. Phone/Fax

Practice location:
  • Phone: 580-504-9479
  • Fax:
Mailing address:
  • Phone: 580-504-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21724-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: