Provider Demographics
NPI:1932476017
Name:HOGEBOON, BETTY JANE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JANE
Last Name:HOGEBOON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 COUNTY ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:13167-3208
Mailing Address - Country:US
Mailing Address - Phone:315-625-7925
Mailing Address - Fax:
Practice Address - Street 1:2050 STATE ROUTE 49
Practice Address - Street 2:
Practice Address - City:NORTH BAY
Practice Address - State:NY
Practice Address - Zip Code:13123
Practice Address - Country:US
Practice Address - Phone:315-245-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist