Provider Demographics
NPI:1295946085
Name:HOGAN, AMANDA (SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 BACKBAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-8918
Mailing Address - Country:US
Mailing Address - Phone:614-353-8595
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2262
Practice Address - Country:US
Practice Address - Phone:614-889-6320
Practice Address - Fax:614-889-7532
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist