Provider Demographics
NPI:1346641339
Name:HOGAN, CHELSIE (ATC, LAT, MED)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:ATC, LAT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 GROSSE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54141-8966
Mailing Address - Country:US
Mailing Address - Phone:920-621-8455
Mailing Address - Fax:
Practice Address - Street 1:1630 COMMANCHE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-430-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1609-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer