Basic Information
| Provider Information | |||||||||
| NPI: | 1326123282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOGT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | LICSW,CADC III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4811 S 76TH STREET | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625423255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4811 S 76TH STREET | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625423255 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 972 | WI | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 6569 | WI | X | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041S0200X | WI | X | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.