Provider Demographics
NPI:1326273590
Name:HOFMEISTER, JENNIFER LEE (BS, CSAC, ICS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:BS, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1032
Mailing Address - Country:US
Mailing Address - Phone:262-632-1780
Mailing Address - Fax:262-632-0895
Practice Address - Street 1:524 MAIN ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1032
Practice Address - Country:US
Practice Address - Phone:262-632-1780
Practice Address - Fax:262-632-0895
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15284-132101YA0400X
WI15373-135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)