Provider Demographics
NPI:1093088817
Name:HOFFMAN, REBECCA L (MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 1ST ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1927
Mailing Address - Country:US
Mailing Address - Phone:320-356-0308
Mailing Address - Fax:320-316-3560
Practice Address - Street 1:3400 1ST ST N STE 300
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1927
Practice Address - Country:US
Practice Address - Phone:320-356-0308
Practice Address - Fax:320-316-3560
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN724920100Medicaid
1649726910OtherTYPE 2 NPI