Healthcare Provider Details

I. General information

NPI: 1497351324
Provider Name (Legal Business Name): CHARLENE HOFFMEISTER M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 05/13/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 SW 28TH STREET REDMOND
REDMOND OR
97756
US

IV. Provider business mailing address

652 NW GREEN FOREST CIR
REDMOND OR
97756-1459
US

V. Phone/Fax

Practice location:
  • Phone: 503-453-3862
  • Fax:
Mailing address:
  • Phone: 541-604-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number015765
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: