Provider Demographics
NPI:1972928299
Name:HOFFER, KELLIE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:HOFFER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3514
Mailing Address - Country:US
Mailing Address - Phone:401-663-8170
Mailing Address - Fax:
Practice Address - Street 1:500 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5048
Practice Address - Country:US
Practice Address - Phone:401-272-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP011171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist