Provider Demographics
NPI:1346479045
Name:HOEKSTRA, CAROLYN BEA
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BEA
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18642 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3514
Mailing Address - Country:US
Mailing Address - Phone:708-257-8970
Mailing Address - Fax:
Practice Address - Street 1:18642 HENRY ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3514
Practice Address - Country:US
Practice Address - Phone:708-257-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist