Provider Demographics
NPI:1083267538
Name:VOGEL, JACQUELYNN
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GRAHAM PL
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1604
Mailing Address - Country:US
Mailing Address - Phone:973-997-9062
Mailing Address - Fax:
Practice Address - Street 1:15 GRAHAM PL
Practice Address - Street 2:
Practice Address - City:WANAQUE
Practice Address - State:NJ
Practice Address - Zip Code:07465-1604
Practice Address - Country:US
Practice Address - Phone:973-997-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist