1114342037 NPI number — MS. LAUREN KIMBERLY HOFIUS CSA

Table of content: MS. LAUREN KIMBERLY HOFIUS CSA (NPI 1114342037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114342037 NPI number — MS. LAUREN KIMBERLY HOFIUS CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFIUS
Provider First Name:
LAUREN
Provider Middle Name:
KIMBERLY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CSA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114342037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4211 N CICERO AVE
Provider Second Line Business Mailing Address:
#400
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60641-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-794-3100
Provider Business Mailing Address Fax Number:
773-685-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4211 N CICERO AVE
Provider Second Line Business Practice Location Address:
#400
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60641-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-794-3100
Provider Business Practice Location Address Fax Number:
773-685-4520
Provider Enumeration Date:
02/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X , with the licence number:  238.000410 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZC0007X , with the licence number: 4201 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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