Provider Demographics
NPI:1316143761
Name:HOFER, PAMINA J (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMINA
Middle Name:J
Last Name:HOFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E LADD ST
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8860
Mailing Address - Country:US
Mailing Address - Phone:509-299-2451
Mailing Address - Fax:509-299-4649
Practice Address - Street 1:982 E COLUMBIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-3316
Practice Address - Country:US
Practice Address - Phone:509-685-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60131626101Y00000X
GUCP012103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist