Provider Demographics
NPI:1194136648
Name:HOGAN, CAROL (MS, CCC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:IANNOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC
Mailing Address - Street 1:54 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3316
Mailing Address - Country:US
Mailing Address - Phone:203-927-9700
Mailing Address - Fax:
Practice Address - Street 1:54 POTTER RD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-927-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9522235Z00000X
CT003482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist