Provider Demographics
NPI:1912089988
Name:HOOGTERP, LINDA L (LMSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:HOOGTERP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GRANGE HALL RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8836
Mailing Address - Country:US
Mailing Address - Phone:248-627-2326
Mailing Address - Fax:248-627-2326
Practice Address - Street 1:9460 S SAGINAW RD
Practice Address - Street 2:SUITE D
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8207
Practice Address - Country:US
Practice Address - Phone:810-695-9466
Practice Address - Fax:810-695-4311
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1011272Medicare UPIN
MI538653Medicare UPIN
MI8008978920Medicare UPIN