Basic Information
| Provider Information | |||||||||
| NPI: | 1811353329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGLUND | ||||||||
| FirstName: | NICHOLA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14115 JAMES RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553749417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635758086 | ||||||||
| FaxNumber: | 3207740415 | ||||||||
| Practice Location | |||||||||
| Address1: | 14115 JAMES RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553749417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635758086 | ||||||||
| FaxNumber: | 3207740415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 3010 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.