Provider Demographics
NPI:1720608755
Name:HOGAN, SARAH MARIE (IBCLC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LOETSCHER PL APT 117
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5960
Mailing Address - Country:US
Mailing Address - Phone:512-589-1476
Mailing Address - Fax:
Practice Address - Street 1:201 LOETSCHER PL APT 117
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5960
Practice Address - Country:US
Practice Address - Phone:512-589-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-160690174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN