Healthcare Provider Details

I. General information

NPI: 1528422003
Provider Name (Legal Business Name): KRISTY HOFSTETTER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 W NATIONAL AVE STE 150
MILWAUKEE WI
53227-2145
US

IV. Provider business mailing address

2534 N 124TH ST APT 257
WAUWATOSA WI
53226-1059
US

V. Phone/Fax

Practice location:
  • Phone: 414-395-4485
  • Fax:
Mailing address:
  • Phone: 262-510-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4079
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: