Provider Demographics
NPI:1629330568
Name:HOAG, JESSICA C (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:HOAG
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5324
Mailing Address - Country:US
Mailing Address - Phone:518-271-6777
Mailing Address - Fax:
Practice Address - Street 1:435 4TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-5324
Practice Address - Country:US
Practice Address - Phone:518-271-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY366596091252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency