MEDICARE: DR. KATHLEEN MARY VOGLER PH.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	20041410A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7393696	OTHER		AETNA
2	187004463559	OTHER		CORPHEALTH
3	0001133252	OTHER		MHN
4	000000361991	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1104934900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MARY VOGLER PH.D.

Provider Business Mailing Address
First Line	:	9247 N MERIDIAN ST
Second Line	:	SUITE 104
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1879
Country	:	US
Telephone Number	:	317-815-6030
Fax Number	:	317-815-6031

Provider Business Practice Location Address
First Line	:	9247 N MERIDIAN ST
Second Line	:	SUITE 104
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1879
Country	:	US
Telephone Number	:	317-815-6030
Fax Number	:	317-815-6031

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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