MEDICARE: MRS. JESSICA HOGUE MCD, 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	SP#2676	AR

General Provider Information

NPI Number	:	1982844759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA HOGUE MCD, CCC-SLP

Provider Business Mailing Address
First Line	:	3855 ANTIOCH RD
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-9535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 ANTIOCH RD
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-9535
Country	:	US
Telephone Number	:	870-307-4440
Fax Number	:

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

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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