Provider Demographics
NPI:1831511906
Name:HOFMANN, JACKLYN (LPCC)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2058
Mailing Address - Country:US
Mailing Address - Phone:440-260-8300
Mailing Address - Fax:440-260-8305
Practice Address - Street 1:3094 W MARKET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3626
Practice Address - Country:US
Practice Address - Phone:440-260-2916
Practice Address - Fax:330-983-9310
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional