Provider Demographics
NPI:1265564306
Name:HOGAN, TERESA ELENA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ELENA
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 TRAIL RIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3212
Mailing Address - Country:US
Mailing Address - Phone:505-898-0774
Mailing Address - Fax:
Practice Address - Street 1:7604 TRAIL RIDGE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3212
Practice Address - Country:US
Practice Address - Phone:505-898-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4001235Z00000X
NM4171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist