Healthcare Provider Details

I. General information

NPI: 1023286267
Provider Name (Legal Business Name): MARY HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CHESTNUT ST
CHICAGO IL
60611-2014
US

IV. Provider business mailing address

123 N STRATFORD RD
ARLINGTON HEIGHTS IL
60004-6523
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-8425
  • Fax: 312-943-4459
Mailing address:
  • Phone: 847-624-6087
  • Fax: 312-943-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: