Provider Demographics
NPI:1942884424
Name:HOGE, JOCELYN
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:HOGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S 1400 W
Mailing Address - Street 2:
Mailing Address - City:PINGREE
Mailing Address - State:ID
Mailing Address - Zip Code:83262-1324
Mailing Address - Country:US
Mailing Address - Phone:208-604-3018
Mailing Address - Fax:
Practice Address - Street 1:555 S 1400 W
Practice Address - Street 2:
Practice Address - City:PINGREE
Practice Address - State:ID
Practice Address - Zip Code:83262-1324
Practice Address - Country:US
Practice Address - Phone:208-604-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-4699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist