Provider Demographics
NPI:1265942569
Name:VOGEL, VIRGINIA
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 HANLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8705
Mailing Address - Country:US
Mailing Address - Phone:715-381-1980
Mailing Address - Fax:715-381-1906
Practice Address - Street 1:2201 JACK BREAULT DR STE 200
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4547
Practice Address - Country:US
Practice Address - Phone:715-629-8300
Practice Address - Fax:715-381-8301
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3680-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI101YP2500XMedicaid