Provider Demographics
NPI:1235426206
Name:HOFFMANN, AMY L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HOFFMANN
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 1:125 RENATA CT
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1364
Mailing Address - Country:US
Mailing Address - Phone:608-347-5551
Mailing Address - Fax:
Practice Address - Street 1:125 RENATA CT
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1364
Practice Address - Country:US
Practice Address - Phone:608-347-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9481-1231041C0700X
WI18721-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)