Provider Demographics
NPI:1780417345
Name:HOFFMAN, KILEY (MS, SLP-CF)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PORTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1525
Mailing Address - Country:US
Mailing Address - Phone:510-504-3034
Mailing Address - Fax:
Practice Address - Street 1:210 PORTER DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1525
Practice Address - Country:US
Practice Address - Phone:510-504-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty