Provider Demographics
NPI:1114233210
Name:RANEY, MICHELLE LYNN-HOGG (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN-HOGG
Last Name:RANEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N BROADWAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2212
Mailing Address - Country:US
Mailing Address - Phone:859-353-3666
Mailing Address - Fax:859-448-7077
Practice Address - Street 1:210 N BROADWAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2212
Practice Address - Country:US
Practice Address - Phone:859-353-3666
Practice Address - Fax:859-448-7077
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3991235Z00000X
235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100346980Medicaid