Provider Demographics
NPI:1821785221
Name:HOGAN, SHANNON MAUREEN (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MAUREEN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:S. MAURI
Other - Middle Name:
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:40 E OAK ST APT 609
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1209
Mailing Address - Country:US
Mailing Address - Phone:513-646-4544
Mailing Address - Fax:
Practice Address - Street 1:100 FOLSOM PRISON RD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-0001
Practice Address - Country:US
Practice Address - Phone:916-985-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program