Provider Demographics
NPI:1598099244
Name:VOGT, ALLEN J (PHD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:J
Last Name:VOGT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-329-7000
Mailing Address - Fax:414-329-7010
Practice Address - Street 1:10201 W LINCOLN AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2136
Practice Address - Country:US
Practice Address - Phone:414-329-7000
Practice Address - Fax:414-329-7010
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI404-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI404-123OtherSTATE OF WISCONSIN-LICENSED