Provider Demographics
NPI:1144511817
Name:KOGAN, DOROTHY ALICE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ALICE
Last Name:KOGAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:ALICE
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2506 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:610-639-8676
Mailing Address - Fax:
Practice Address - Street 1:2506 PINE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:610-639-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020903-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist