Provider Demographics
NPI:1578877577
Name:HOGAN, LAUREN (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-8150
Mailing Address - Country:US
Mailing Address - Phone:414-224-8219
Mailing Address - Fax:414-224-8246
Practice Address - Street 1:807 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-8150
Practice Address - Country:US
Practice Address - Phone:414-224-8219
Practice Address - Fax:414-224-8246
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017947225100000X
WI12087-242251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic