Individual
RAINA HODGSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
12210 259TH AVE, TREVOR, WI 53179-9590
(847) 912-1031
Mailing address
12210 259TH AVE, TREVOR, WI 53179-9590
(847) 912-1031
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.005842
IL
235Z00000X
Speech-Language Pathologist
3547-154
WI
Other
Enumeration date
06/15/2009
Last updated
09/04/2012
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