Provider Demographics
NPI:1114219953
Name:VOGEL, MICHAEL JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 S COBB ST UNIT 3610
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1399
Mailing Address - Country:US
Mailing Address - Phone:907-921-1293
Mailing Address - Fax:907-416-5455
Practice Address - Street 1:13036 OLD GLENN HWY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7566
Practice Address - Country:US
Practice Address - Phone:907-921-1293
Practice Address - Fax:907-416-5455
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical