Provider Demographics
NPI:1124001508
Name:HOFMEISTER, MICHELLE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 HARTREY AV
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-491-6829
Mailing Address - Fax:
Practice Address - Street 1:50 E WASHINGTON ST STE 301
Practice Address - Street 2:ST JAMES CATHEDRAL COUNSELING CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2142
Practice Address - Country:US
Practice Address - Phone:312-337-5874
Practice Address - Fax:312-337-9243
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15882Medicare ID - Type Unspecified