Provider Demographics
NPI:1255797338
Name:VOGT, JENNIFER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
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 1:1785 W STADIUM BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5285
Mailing Address - Country:US
Mailing Address - Phone:734-913-1093
Mailing Address - Fax:734-369-2683
Practice Address - Street 1:1785 W STADIUM BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5285
Practice Address - Country:US
Practice Address - Phone:734-913-1093
Practice Address - Fax:734-369-2683
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical