Healthcare Provider Details

I. General information

NPI: 1316167513
Provider Name (Legal Business Name): AMY D HOGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY D HOGAN LCSW

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5018
US

IV. Provider business mailing address

5310 E 31ST ST
TULSA OK
74135-5018
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-3729
  • Fax:
Mailing address:
  • Phone: 918-600-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2790
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: