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NPI Code Detail

MEDICARE: DR. KELLY GRAHAM HOFFMANN PSYD

MEDICARE:  DR. KELLY GRAHAM HOFFMANN  PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist71006989IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144397001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY GRAHAM HOFFMANN PSYD
Provider Business Mailing Address
First Line : 6055 N FOREST GLEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60646-5013
Country : US
Telephone Number : 312-339-8189
Fax Number :
Provider Business Practice Location Address
First Line : 800 E NORTHWEST HWY STE 206
Second Line :
City : MOUNT PROSPECT
State : IL
Zip : 60056-3457
Country : US
Telephone Number : 847-696-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 04/14/2026

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Directions to “ DR. KELLY GRAHAM HOFFMANN PSYD” Practice Location

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