Provider Demographics
NPI:1295133106
Name:VOGT, ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WINGATE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-9758
Mailing Address - Country:US
Mailing Address - Phone:217-320-1818
Mailing Address - Fax:
Practice Address - Street 1:2035 W ILES AVE STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7000
Practice Address - Country:US
Practice Address - Phone:217-726-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist