Provider Demographics
NPI:1518336767
Name:HOFFMAN, JASON ROBERT (MS LPCC LADC NCC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MS LPCC LADC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 MULLIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2318
Mailing Address - Country:US
Mailing Address - Phone:507-327-9738
Mailing Address - Fax:
Practice Address - Street 1:501 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6109
Practice Address - Country:US
Practice Address - Phone:507-327-9738
Practice Address - Fax:507-344-1146
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301969101YA0400X
MNCC01043101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional