Provider Demographics
NPI:1194131565
Name:HOGREFE, BROOKE (MA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HOGREFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12152 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1779
Mailing Address - Country:US
Mailing Address - Phone:149-140-9043
Mailing Address - Fax:314-270-8133
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1779
Practice Address - Country:US
Practice Address - Phone:149-140-9043
Practice Address - Fax:314-270-8133
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015005066101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490035007Medicaid