MEDICARE: MACKENZIE NICOLE HOGAN MSW, CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	104100000X	Social Worker	255894	KY

General Provider Information

NPI Number	:	1366091407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE NICOLE HOGAN MSW, CSW

Provider Business Mailing Address
First Line	:	4030 TATES CREEK RD APT 2963
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3093
Country	:	US
Telephone Number	:	513-659-9128
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 TATES CREEK RD APT 2963
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3093
Country	:	US
Telephone Number	:	513-659-9128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	06/25/2025

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