Provider Demographics
NPI:1114446754
Name:HOFFMANN, STEPHEN RODGER
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RODGER
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 TREASURE DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7947
Mailing Address - Country:US
Mailing Address - Phone:904-562-8428
Mailing Address - Fax:
Practice Address - Street 1:1737 S NAPERVILLE RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5894
Practice Address - Country:US
Practice Address - Phone:630-682-2833
Practice Address - Fax:630-682-2833
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional