Provider Demographics
NPI:1205579869
Name:HOGAN, LAKIESHA (MSW)
Entity type:Individual
Prefix:
First Name:LAKIESHA
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8039 S EVANS AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4076
Mailing Address - Country:US
Mailing Address - Phone:773-946-6792
Mailing Address - Fax:
Practice Address - Street 1:3062 E 91ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4401
Practice Address - Country:US
Practice Address - Phone:773-718-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker