Healthcare Provider Details

I. General information

NPI: 1972614790
Provider Name (Legal Business Name): JENNIFER LOUISE HOGG ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BOSTON RD
HAVERHILL MA
01835-6927
US

IV. Provider business mailing address

5 WITCH LN
PLAISTOW NH
03865-2233
US

V. Phone/Fax

Practice location:
  • Phone: 603-681-3570
  • Fax:
Mailing address:
  • Phone: 603-382-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0025
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: