Provider Demographics
NPI:1578733119
Name:HOGAN, RICHARD M II (MS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:HOGAN
Suffix:II
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 HOLLY TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2427
Mailing Address - Country:US
Mailing Address - Phone:314-620-6019
Mailing Address - Fax:
Practice Address - Street 1:11630 STUDT AVE
Practice Address - Street 2:STE 210
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7394
Practice Address - Country:US
Practice Address - Phone:314-532-0682
Practice Address - Fax:314-455-3777
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001032148231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO514000002Medicare PIN