=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740845494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEFANIE PAULA HOFMAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2019
-----------------------------------------------------
Last Update Date | 05/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8401 WAYZATA BLVD STE 340
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55426-1365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-566-0088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 422 WABASHA ST
-----------------------------------------------------
City | SAINT PETER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56082-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-412-4881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3622
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------