Provider Demographics
NPI:1932238490
Name:HOGAN, JACQUELINE ANITA (LSCSW,LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANITA
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LSCSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 N 43RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-3424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:753 STATE AVE
Practice Address - Street 2:SUITE 660
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2516
Practice Address - Country:US
Practice Address - Phone:913-244-8443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020160741041C0700X
KS22641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical