Provider Demographics
NPI:1437663515
Name:TESS HOGAN SLP, INC.
Entity Type:Organization
Organization Name:TESS HOGAN SLP, INC.
Other - Org Name:BANYAN VOICE AND SPEECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:941-330-2425
Mailing Address - Street 1:1273 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-8460
Mailing Address - Country:US
Mailing Address - Phone:941-330-2425
Mailing Address - Fax:941-330-2425
Practice Address - Street 1:1273 18TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8460
Practice Address - Country:US
Practice Address - Phone:941-330-2425
Practice Address - Fax:941-330-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty