Provider Demographics
NPI:1730487323
Name:VOGEL, SALLY JO (PHD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JO
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:JO
Other - Last Name:BARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:222 W THOMAS RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4419
Mailing Address - Country:US
Mailing Address - Phone:602-406-6238
Mailing Address - Fax:
Practice Address - Street 1:222 W THOMAS RD
Practice Address - Street 2:SUITE 315
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4419
Practice Address - Country:US
Practice Address - Phone:602-406-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist