Provider Demographics
NPI:1750654596
Name:HOFFMAN, IAN E (PSYD)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:E
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9817
Mailing Address - Country:US
Mailing Address - Phone:320-260-5915
Mailing Address - Fax:
Practice Address - Street 1:11800 S 75TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1033
Practice Address - Country:US
Practice Address - Phone:708-671-8440
Practice Address - Fax:630-859-2994
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical