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General NPI Number Information
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NPI Number | 1831511906
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Entity Type | Individual
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Provider Name | JACKLYN HOFMANN LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 3094 W MARKET ST SUITE 105
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City | FAIRLAWN
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State | OH
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Zip | 44333-3626
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Country | US
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Telephone | 440-260-2916
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Fax | 330-983-9310
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Provider Business Mailing Address
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Address Line | 202 E BAGLEY RD
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City | BEREA
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State | OH
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Zip | 44017-2058
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Country | US
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Telephone | 440-260-8300
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Fax | 440-260-8305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0900189
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License Number State | OH
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