Provider Demographics
NPI:1063048353
Name:HOFFMAN, JESSIE BALDWIN (PHD, RD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:BALDWIN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 HIDEAWAY LN APT 108
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6090
Mailing Address - Country:US
Mailing Address - Phone:803-669-3978
Mailing Address - Fax:
Practice Address - Street 1:1031 HIDEAWAY LN APT 108
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6090
Practice Address - Country:US
Practice Address - Phone:803-669-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLRD.2161.RD133V00000X
NCL007656133V00000X
IL164.010291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty