Provider Demographics
NPI:1104307099
Name:HOGAN, COLLEEN (MS CF SLP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 KAAWA ST # A
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4985
Mailing Address - Country:US
Mailing Address - Phone:708-969-1635
Mailing Address - Fax:
Practice Address - Street 1:179 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1625
Practice Address - Country:US
Practice Address - Phone:630-479-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004963235Z00000X
HISP-2009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist