Provider Demographics
NPI:1558895896
Name:HOGAN, DYLAN
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY PL
Mailing Address - Street 2:
Mailing Address - City:LAMONI
Mailing Address - State:IA
Mailing Address - Zip Code:50140-1641
Mailing Address - Country:US
Mailing Address - Phone:641-784-5392
Mailing Address - Fax:641-784-5039
Practice Address - Street 1:1 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:LAMONI
Practice Address - State:IA
Practice Address - Zip Code:50140-1641
Practice Address - Country:US
Practice Address - Phone:641-784-5392
Practice Address - Fax:641-784-5039
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0007922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA000792OtherIOWA DEPARTMENT OF PUBLIC HEALTH