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General NPI Number Information
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NPI Number | 1104307099
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Entity Type | Individual
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Provider Name | COLLEEN HOGAN M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 2707 THAYER DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2538
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Country | US
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Telephone | 708-969-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 2707 THAYER DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2538
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Country | US
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Telephone | 708-969-1635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.004963
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-2009
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License Number State | HI
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