Provider Demographics
NPI:1851556500
Name:HOAG, JOHN MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:HOAG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3267
Mailing Address - Country:US
Mailing Address - Phone:815-212-6320
Mailing Address - Fax:678-716-0866
Practice Address - Street 1:404 W GREEN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3267
Practice Address - Country:US
Practice Address - Phone:815-212-6320
Practice Address - Fax:678-716-0866
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490118601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211119001Medicare PIN