Provider Demographics
NPI:1275014383
Name:HOGLUND, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:HOGLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:JAMES
Other - Last Name:HOGLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18 MEETING ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2909
Mailing Address - Country:US
Mailing Address - Phone:207-712-6304
Mailing Address - Fax:
Practice Address - Street 1:18 MEETING ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2909
Practice Address - Country:US
Practice Address - Phone:207-712-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician