Provider Demographics
NPI:1831487420
Name:HOGAN, ROY EVERETT (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:EVERETT
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MSW, LCSW
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 974
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-0974
Mailing Address - Country:US
Mailing Address - Phone:509-551-9364
Mailing Address - Fax:
Practice Address - Street 1:676 W 130 S UNIT A
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4813
Practice Address - Country:US
Practice Address - Phone:509-551-9364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10640565-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical