Provider Demographics
NPI:1598235715
Name:HOFFMASTER, WESLEY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:HOFFMASTER
Suffix:
Gender:M
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MI
Mailing Address - Zip Code:49328-9724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3260 E B AVE
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-8904
Practice Address - Country:US
Practice Address - Phone:269-349-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist