Healthcare Provider Details

I. General information

NPI: 1821785221
Provider Name (Legal Business Name): SHANNON MAUREEN HOGAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: S. MAURI HOGAN MA

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FOLSOM PRISON RD
REPRESA CA
95671-0001
US

IV. Provider business mailing address

40 E OAK ST APT 609
CHICAGO IL
60611-1209
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-8610
  • Fax:
Mailing address:
  • Phone: 513-646-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: