MEDICARE: MRS. KIMBERLY ANN HOGAN M.S. MFC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1538454764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN HOGAN M.S. MFC

Provider Business Mailing Address
First Line	:	1574 SW FRESNO RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4329
Country	:	US
Telephone Number	:	772-634-0470
Fax Number	:	772-634-0470

Provider Business Practice Location Address
First Line	:	1574 SW FRESNO RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4329
Country	:	US
Telephone Number	:	772-634-0470
Fax Number	:	772-634-0470

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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