Provider Demographics
NPI:1700392149
Name:HOGAN, VALERIE LYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13445 W IROQUOIS TRL
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8189
Mailing Address - Country:US
Mailing Address - Phone:773-505-9773
Mailing Address - Fax:
Practice Address - Street 1:1333 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3823
Practice Address - Country:US
Practice Address - Phone:815-588-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist