MEDICARE: KAILEIGH HOGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1275285306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEIGH HOGAN

Provider Business Mailing Address
First Line	:	34 COOLIDGE RD
Second Line	:
City	:	ALLSTON
State	:	MA
Zip	:	02134-1524
Country	:	US
Telephone Number	:	617-894-0858
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CHARLES ST
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-1403
Country	:	US
Telephone Number	:	617-635-6470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	01/20/2022

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Directions to “ KAILEIGH HOGAN ” Practice Location

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