Provider Demographics
NPI:1861991515
Name:HOFFMAN, KELLIE ANNE (LSW)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:ANNE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 BERLIN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2069
Mailing Address - Country:US
Mailing Address - Phone:814-701-2898
Mailing Address - Fax:814-701-2917
Practice Address - Street 1:485 BERLIN PLANK RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2069
Practice Address - Country:US
Practice Address - Phone:814-701-2898
Practice Address - Fax:814-701-2917
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1861991515Medicaid