Provider Demographics
NPI:1902021652
Name:HOGAN, JODI STUTTS (MS,CCC-A)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:STUTTS
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS,CCC-A
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 2
Mailing Address - Street 2:1248 HUFFMAN MILL ROAD, SUITE 200
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0002
Mailing Address - Country:US
Mailing Address - Phone:336-395-1315
Mailing Address - Fax:
Practice Address - Street 1:1248 HUFFMAN MILL RD STE 200
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-395-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4267231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902021652OtherBCBS
NC7413050Medicaid
NC2699702Medicare PIN