Provider Demographics
NPI:1619161783
Name:VOGT, ELIZABETH P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:P
Last Name:VOGT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 W. LAKE STREET # 208
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2653
Mailing Address - Country:US
Mailing Address - Phone:612-642-1754
Mailing Address - Fax:812-825-4349
Practice Address - Street 1:1406 W. LAKE STREET # 208
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2653
Practice Address - Country:US
Practice Address - Phone:612-642-1754
Practice Address - Fax:612-825-4349
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNLP5540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health