Provider Demographics
NPI:1255364659
Name:HOGUE, MELINDA L (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:HOGUE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 N HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3203
Mailing Address - Country:US
Mailing Address - Phone:724-983-1940
Mailing Address - Fax:724-983-1963
Practice Address - Street 1:689 N HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3203
Practice Address - Country:US
Practice Address - Phone:724-983-1940
Practice Address - Fax:724-983-1963
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019499180001Medicaid
PA019071Medicare ID - Type Unspecified