Provider Demographics
NPI:1881024875
Name:HOGG, ALEXANDER NATHAN (LISW)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NATHAN
Last Name:HOGG
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4156
Mailing Address - Country:US
Mailing Address - Phone:563-210-1291
Mailing Address - Fax:
Practice Address - Street 1:1312 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4156
Practice Address - Country:US
Practice Address - Phone:563-210-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0075901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical