Provider Demographics
NPI:1396059309
Name:HOGAN, CASEY C (SLP)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:C
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 1:507 KNOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4241
Mailing Address - Country:US
Mailing Address - Phone:229-242-1391
Mailing Address - Fax:229-242-1391
Practice Address - Street 1:507 KNOB HILL RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4241
Practice Address - Country:US
Practice Address - Phone:229-242-1391
Practice Address - Fax:229-242-1391
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist