Provider Demographics
NPI:1558107193
Name:HOCKADAY, KIRSTIN MARIE
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARIE
Last Name:HOCKADAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 WASHTENAW AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1481
Mailing Address - Country:US
Mailing Address - Phone:419-297-3895
Mailing Address - Fax:
Practice Address - Street 1:4830 WASHTENAW AVE APT B3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1481
Practice Address - Country:US
Practice Address - Phone:419-297-3895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117757104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker