Healthcare Provider Details

I. General information

NPI: 1164355103
Provider Name (Legal Business Name): EMILY JEAN HOFFERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PATRICK BLVD STE 250
BROOKFIELD WI
53045-5883
US

IV. Provider business mailing address

2417 SPRINGDALE RD APT 2C
WAUKESHA WI
53186-2766
US

V. Phone/Fax

Practice location:
  • Phone: 424-350-9173
  • Fax:
Mailing address:
  • Phone: 414-350-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-525508
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: