Provider Demographics
NPI:1962102376
Name:HOEFT, JORDAN TYLER (LCSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:TYLER
Last Name:HOEFT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 E DALE AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-2304
Mailing Address - Country:US
Mailing Address - Phone:414-892-0209
Mailing Address - Fax:
Practice Address - Street 1:3837 E DALE AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-2304
Practice Address - Country:US
Practice Address - Phone:414-892-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9945-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical