Provider Demographics
NPI:1497201263
Name:VOGT, RACHEL ASHLEEN (PSYCH TECH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ASHLEEN
Last Name:VOGT
Suffix:
Gender:F
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9369 BOCINA LN APT D
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6855
Mailing Address - Country:US
Mailing Address - Phone:661-632-6427
Mailing Address - Fax:
Practice Address - Street 1:9369 BOCINA LN APT D
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6855
Practice Address - Country:US
Practice Address - Phone:661-632-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40116167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician