Provider Demographics
NPI:1285964056
Name:HOGAN, SHIANN MASHAWN (AA)
Entity type:Individual
Prefix:MRS
First Name:SHIANN
Middle Name:MASHAWN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 K ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-4107
Mailing Address - Country:US
Mailing Address - Phone:707-464-7224
Mailing Address - Fax:707-465-4272
Practice Address - Street 1:455 K ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4107
Practice Address - Country:US
Practice Address - Phone:707-464-7224
Practice Address - Fax:707-465-4272
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health