MEDICARE: MRS. CHARLOTTE ANN HOGAN SLP

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	235Z00000X	Speech-Language Pathologist	00331	MO

General Provider Information

NPI Number	:	1477670826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE ANN HOGAN SLP

Provider Business Mailing Address
First Line	:	3 DES CYPRIE PL
Second Line	:
City	:	NEW MADRID
State	:	MO
Zip	:	63869-9767
Country	:	US
Telephone Number	:	573-748-5324
Fax Number	:	573-748-8909

Provider Business Practice Location Address
First Line	:	3 DES CYPRIE PL
Second Line	:
City	:	NEW MADRID
State	:	MO
Zip	:	63869-9767
Country	:	US
Telephone Number	:	573-748-5324
Fax Number	:	573-748-8909

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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