Healthcare Provider Details

I. General information

NPI: 1235426206
Provider Name (Legal Business Name): AMY L HOFFMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 09/20/2021
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RENATA CT
DEFOREST WI
53532-1364
US

IV. Provider business mailing address

125 RENATA CT
DEFOREST WI
53532-1364
US

V. Phone/Fax

Practice location:
  • Phone: 608-347-5551
  • Fax:
Mailing address:
  • Phone: 608-347-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9481-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18721-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: