Provider Demographics
NPI:1396396925
Name:HOAGLAND, BRIELLE LAUREN (MA, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIELLE
Middle Name:LAUREN
Last Name:HOAGLAND
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:MISS
Other - First Name:BRIELLE
Other - Middle Name:LAUREN
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 E MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1640
Mailing Address - Country:US
Mailing Address - Phone:740-277-8299
Mailing Address - Fax:
Practice Address - Street 1:7454 US ROUTE 50
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:45612
Practice Address - Country:US
Practice Address - Phone:740-634-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20191029-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist