MEDICARE: JACQUELINE ANITA HOGAN LSCSW,LCSW

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	1041C0700X	Clinical Social Worker	2002016074	MO
2	1041C0700X	Clinical Social Worker	2264	KS

General Provider Information

NPI Number	:	1932238490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ANITA HOGAN LSCSW,LCSW

Provider Business Mailing Address
First Line	:	2326 N 43RD TER
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-3424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 STATE AVE
Second Line	:	SUITE 660
City	:	KANSAS CITY
State	:	KS
Zip	:	66101-2516
Country	:	US
Telephone Number	:	913-244-8443
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	11/04/2008

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