Provider Demographics
NPI:1689936106
Name:O'HARE HOGAN, MICHELLE GRACE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GRACE
Last Name:O'HARE HOGAN
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 1:6 DECKERT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5901
Mailing Address - Country:US
Mailing Address - Phone:845-226-7367
Mailing Address - Fax:845-226-7367
Practice Address - Street 1:6 DECKERT BLVD
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5901
Practice Address - Country:US
Practice Address - Phone:845-226-7367
Practice Address - Fax:845-226-7367
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146590021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist