Provider Demographics
NPI:1942577614
Name:HOGAN, LAURA JEAN (MA LLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ESTRADA DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2994
Mailing Address - Country:US
Mailing Address - Phone:734-697-5120
Mailing Address - Fax:
Practice Address - Street 1:701 ESTRADA DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2994
Practice Address - Country:US
Practice Address - Phone:734-697-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958OtherAARP
MI1958OtherETNA
MI1958Medicaid
MI1958OtherBLUE CROSS BLUE SHIELD
MI1958OtherUNITES HEALTH CARE
MI1958OtherMICHIGAN BLUE
MI1958OtherBLUE CARE NETWORK
MI1958OtherUNITED HEALTH CARE
MI1958OtherHAP
MI1958OtherAARP