Provider Demographics
NPI:1356611768
Name:HOFFMAN, MCKENZIE NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:NICOLE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:NICOLE
Other - Last Name:MAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2990 CAHILL MAIN STE 204
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2850 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-224-5225
Practice Address - Fax:515-224-5225
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3629-154235Z00000X
IA089447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist