MEDICARE: DEBRA HOGG M.S. CCC-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	SLP-1309	ID

General Provider Information

NPI Number	:	1477921567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA HOGG M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2841 HOMESTEAD LN
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7172
Country	:	US
Telephone Number	:	208-757-1376
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 S UTAH AVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-3322
Country	:	US
Telephone Number	:	208-542-7190
Fax Number	:

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

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/08/2015

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Directions to “ DEBRA HOGG M.S. CCC-SLP” Practice Location

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