Provider Demographics
NPI:1558549832
Name:VOGT, FAWN APRIL (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:APRIL
Last Name:VOGT
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:APRIL
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21000 ROGERS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4926
Mailing Address - Country:US
Mailing Address - Phone:763-291-5505
Mailing Address - Fax:763-657-0819
Practice Address - Street 1:21000 ROGERS DR STE 200
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4926
Practice Address - Country:US
Practice Address - Phone:763-291-5505
Practice Address - Fax:763-657-0819
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301211101YA0400X
MNCC00373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)