Provider Demographics
NPI:1619195005
Name:VOGEL, THERESA L (BS)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:VOGEL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKEMONT PARK BLVD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5947
Mailing Address - Country:US
Mailing Address - Phone:814-946-0261
Mailing Address - Fax:
Practice Address - Street 1:400 LAKEMONT PARK BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5947
Practice Address - Country:US
Practice Address - Phone:814-946-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor