Provider Demographics
NPI:1326632878
Name:VOGEL, ELLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MICHIANA DR
Mailing Address - Street 2:
Mailing Address - City:MICHIANA SHORES
Mailing Address - State:IN
Mailing Address - Zip Code:46360-1193
Mailing Address - Country:US
Mailing Address - Phone:847-987-1908
Mailing Address - Fax:
Practice Address - Street 1:2 EAST DUNES HIGHWAY
Practice Address - Street 2:
Practice Address - City:BEVERLY SHORES
Practice Address - State:IN
Practice Address - Zip Code:46301
Practice Address - Country:US
Practice Address - Phone:847-987-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009107A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical