MEDICARE: DR. GWEN MARIE VOGEL PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY-3054	CO

General Provider Information

NPI Number	:	1558597575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWEN MARIE VOGEL PSY.D.

Provider Business Mailing Address
First Line	:	3457 RINGSBY COURT UNIT 318
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216
Country	:	US
Telephone Number	:	303-880-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	3457 RINGSBY CT UNIT 318
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4914
Country	:	US
Telephone Number	:	303-880-1515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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