Healthcare Provider Details

I. General information

NPI: 1609201789
Provider Name (Legal Business Name): KIMBERLY JOY VOGEL PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 S 87TH AVE
OMAHA NE
68124-3047
US

IV. Provider business mailing address

13460 WALSH DR
BOYS TOWN NE
68010-7529
US

V. Phone/Fax

Practice location:
  • Phone: 918-277-2234
  • Fax:
Mailing address:
  • Phone: 402-498-3358
  • Fax: 402-498-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number882
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: