Provider Demographics
NPI:1548736135
Name:HOFFMAN, ANNA ROSE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:HOFFMAN
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 1:4259 KINGMONT DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1137
Mailing Address - Country:US
Mailing Address - Phone:586-747-7522
Mailing Address - Fax:
Practice Address - Street 1:3601 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2878
Practice Address - Country:US
Practice Address - Phone:872-242-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician