Provider Demographics
NPI:1386253573
Name:HOFFER, JACQUELYN KAY
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KAY
Last Name:HOFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:KAY
Other - Last Name:HARGRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-3204
Mailing Address - Country:US
Mailing Address - Phone:570-436-0435
Mailing Address - Fax:
Practice Address - Street 1:59 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:PA
Practice Address - Zip Code:18224-3204
Practice Address - Country:US
Practice Address - Phone:570-436-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist