Provider Demographics
NPI:1790832723
Name:HOFFMAN, PETER THOMPSON (MS, LP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:THOMPSON
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 HIGHWAY 23 E STE 202
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-1183
Mailing Address - Country:US
Mailing Address - Phone:320-982-1110
Mailing Address - Fax:
Practice Address - Street 1:545 HIGHWAY 23 E STE 202
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1183
Practice Address - Country:US
Practice Address - Phone:320-982-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2073103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN097517600Medicaid
MN01T48HOOtherBLUE CROSS