Provider Demographics
NPI:1144412370
Name:VOGELSANG, RANDALL DAVID (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DAVID
Last Name:VOGELSANG
Suffix:
Gender:M
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85228-4000
Mailing Address - Country:US
Mailing Address - Phone:520-723-2144
Mailing Address - Fax:
Practice Address - Street 1:800 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85228-4000
Practice Address - Country:US
Practice Address - Phone:520-723-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-118151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical