Provider Demographics
NPI:1811564354
Name:HOGLUND, EMILY L
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:HOGLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 E GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2526
Mailing Address - Country:US
Mailing Address - Phone:313-452-2293
Mailing Address - Fax:
Practice Address - Street 1:6821 MEDBURY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-3317
Practice Address - Country:US
Practice Address - Phone:313-922-2222
Practice Address - Fax:866-287-5710
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist