Provider Demographics
NPI:1982844759
Name:HOGUE, JESSICA (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HOGUE
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72579-9535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:SULPHUR ROCK
Practice Address - State:AR
Practice Address - Zip Code:72579-9535
Practice Address - Country:US
Practice Address - Phone:870-307-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist