Provider Demographics
NPI:1265061832
Name:HOFBAUER, SARAH JOY NICOLE (MA, CCC- SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JOY NICOLE
Last Name:HOFBAUER
Suffix:
Gender:F
Credentials:MA, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-403-6780
Mailing Address - Fax:
Practice Address - Street 1:5722 METRO WAY SW STE B
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9524
Practice Address - Country:US
Practice Address - Phone:616-840-7529
Practice Address - Fax:616-840-9693
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018027755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist