Provider Demographics
NPI:1730444670
Name:HOFFEDITZ, LORI L (PHD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:HOFFEDITZ
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 1:10412 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2052
Mailing Address - Country:US
Mailing Address - Phone:317-578-9200
Mailing Address - Fax:
Practice Address - Street 1:10412 ALLISONVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2052
Practice Address - Country:US
Practice Address - Phone:317-578-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002367A101YM0800X
OHE0004092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health