Healthcare Provider Details

I. General information

NPI: 1528431905
Provider Name (Legal Business Name): SARA HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CENTRAL AVE
WELLSBORO PA
16901-1857
US

IV. Provider business mailing address

37 CENTRAL AVE
WELLSBORO PA
16901-1857
US

V. Phone/Fax

Practice location:
  • Phone: 570-732-8040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL012652
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: