Provider Demographics
NPI:1508207937
Name:VOGT, KRISTINA (ATR, LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:ATR, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 N LINCOLN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1807
Mailing Address - Country:US
Mailing Address - Phone:773-466-4527
Mailing Address - Fax:
Practice Address - Street 1:4305 N LINCOLN AVE STE K
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1807
Practice Address - Country:US
Practice Address - Phone:773-466-4527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178007736101YP2500X
IL180008745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional