Healthcare Provider Details

I. General information

NPI: 1154986974
Provider Name (Legal Business Name): DAVID VOGEL LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 S CEDAR ST
LANSING MI
48910-5461
US

IV. Provider business mailing address

4305 S CEDAR ST
LANSING MI
48910-5461
US

V. Phone/Fax

Practice location:
  • Phone: 708-925-5116
  • Fax:
Mailing address:
  • Phone: 517-887-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: