Provider Demographics
NPI:1639637010
Name:HOFFMAN, MADISON DALE (LSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:DALE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3714
Mailing Address - Country:US
Mailing Address - Phone:612-343-3265
Mailing Address - Fax:612-343-3267
Practice Address - Street 1:2445 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3714
Practice Address - Country:US
Practice Address - Phone:612-343-3265
Practice Address - Fax:612-343-3267
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27028104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker