| Doctor Name: | MS. JACQUELYN DIANE HOAG |
| NPI Number: | 1003925843 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LISW |
| License Number: | I-05770 |
| Business Practice Address: | 1472 1/2 S Saint Francis Dr Santa Fe, NM - 875054038 |
| Business Phone Number: | 5056030229 |
| Business Fax Number: | 5054749229 |
| Mailing Address: | 7559 Kachina Loop, SANTA FE |
| State: | NM |
| Postal Code: | 875078440 |
| Phone Number: | 5054748088 |
| Fax Number: | 5054749229 |
| NPI Enumeration Date: | 08/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-05770 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |