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NPI Code Detail

MEDICARE: PETER HOPKINS

MEDICARE: PETER HOPKINS
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
1101Y00000XCounselor
21041C0700XClinical Social Worker149021118IL

General Provider Information

NPI Number : 1528421203
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER HOPKINS
Provider Business Mailing Address
First Line : 1425 W LINCOLN HWY
Second Line :
City : DEKALB
State : IL
Zip : 60115-2825
Country : US
Telephone Number : 815-753-6000
Fax Number :
Provider Business Practice Location Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-423-6961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2016
Last Update Date : 04/14/2021

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