Provider Demographics
NPI:1073097416
Name:HOGAN, TERESA LYNN
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:HOGAN
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:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:CORY
Mailing Address - State:IN
Mailing Address - Zip Code:47846-0035
Mailing Address - Country:US
Mailing Address - Phone:812-243-5134
Mailing Address - Fax:
Practice Address - Street 1:5264 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CORY
Practice Address - State:IN
Practice Address - Zip Code:47846-0035
Practice Address - Country:US
Practice Address - Phone:812-243-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist