Provider Demographics
NPI:1225278864
Name:VOGT, WENDY J (LMP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:VOGT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 143RD ST SW
Mailing Address - Street 2:#B
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-4884
Mailing Address - Country:US
Mailing Address - Phone:206-280-2165
Mailing Address - Fax:
Practice Address - Street 1:6226 196TH ST SW
Practice Address - Street 2:SUITE D2
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5959
Practice Address - Country:US
Practice Address - Phone:206-280-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055793WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist