Provider Demographics
NPI:1619226024
Name:HOGG, LAUREN (LISW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HOGG
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-5277
Mailing Address - Country:US
Mailing Address - Phone:216-672-8208
Mailing Address - Fax:
Practice Address - Street 1:215 MILLER RD STE 7
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1013
Practice Address - Country:US
Practice Address - Phone:440-742-1661
Practice Address - Fax:833-450-0400
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384435Medicaid