Basic Information
| Provider Information | |||||||||
| NPI: | 1346826989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | MEAGAN | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24327 S TONKA AVE | ||||||||
| Address2: | |||||||||
| City: | CHANNAHON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604109717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157689125 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33431 13TH PL S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538747634 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101Y00000X | MC61156749 | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.