Provider Demographics
NPI:1821352600
Name:HOFFACKER, LEIGH ANN
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:HOFFACKER
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 1:7480 CARLIN LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-8392
Mailing Address - Country:US
Mailing Address - Phone:812-988-0823
Mailing Address - Fax:765-628-7401
Practice Address - Street 1:7480 CARLIN LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-8392
Practice Address - Country:US
Practice Address - Phone:812-988-0823
Practice Address - Fax:765-628-7401
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11210438103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst