Provider Demographics
NPI:1710013412
Name:VOGT, MARLENE R (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:R
Last Name:VOGT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10187 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142
Mailing Address - Country:US
Mailing Address - Phone:847-791-4089
Mailing Address - Fax:847-669-9429
Practice Address - Street 1:10187 BENNINGTON DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-2336
Practice Address - Country:US
Practice Address - Phone:847-791-4089
Practice Address - Fax:847-669-9429
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist