Provider Demographics
NPI:1598958423
Name:HOGAN, SUSAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials: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:PO BOX 7986
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-7986
Mailing Address - Country:US
Mailing Address - Phone:706-372-4349
Mailing Address - Fax:706-369-6739
Practice Address - Street 1:1175 OGLETHORPE AVE
Practice Address - Street 2:B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2129
Practice Address - Country:US
Practice Address - Phone:706-372-4349
Practice Address - Fax:706-369-6739
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist