Basic Information
Provider Information
NPI: 1346579679
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOPPEL
FirstName: LINDA
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MPA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 403 E MADISON ST
Address2:  
City: SOUTH BEND
State: IN
PostalCode: 466172322
CountryCode: US
TelephoneNumber: 5742340061
FaxNumber: 5742831209
Practice Location
Address1: 403 E MADISON ST
Address2:  
City: SOUTH BEND
State: IN
PostalCode: 466172322
CountryCode: US
TelephoneNumber: 5742340061
FaxNumber: 5742831209
Other Information
ProviderEnumerationDate: 12/16/2009
LastUpdateDate: 12/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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