Provider Demographics
NPI:1518215185
Name:HOGAN, STACY POPE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:POPE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 WILDWOOD CV
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5861
Mailing Address - Country:US
Mailing Address - Phone:731-885-9492
Mailing Address - Fax:
Practice Address - Street 1:209 JOHN C JONES PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2707
Practice Address - Country:US
Practice Address - Phone:731-479-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist