MEDICARE: KAIJA DANIEL-HOFFMAN LCSW

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
1	1041C0700X	Clinical Social Worker	L7155	OR
2	101YS0200X	School Counselor	151747	OR

General Provider Information

NPI Number	:	1679903439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIJA DANIEL-HOFFMAN LCSW

Provider Business Mailing Address
First Line	:	2425 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7730
Country	:	US
Telephone Number	:	503-866-1452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7730
Country	:	US
Telephone Number	:	503-866-1452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	10/30/2024

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