Provider Demographics
NPI:1306018726
Name:HOGAN, SUZANNE MICHELLE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELLE
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 1:350 IRVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1804 NE LOOP 410
Practice Address - Street 2:220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5211
Practice Address - Country:US
Practice Address - Phone:210-829-5777
Practice Address - Fax:210-829-5972
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist