MEDICARE: DR. ELIZABETH P. VOGT 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	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	LP5540	MN

General Provider Information

NPI Number	:	1619161783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH P. VOGT PSY.D.

Provider Business Mailing Address
First Line	:	1406 W. LAKE STREET # 208
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2653
Country	:	US
Telephone Number	:	612-642-1754
Fax Number	:	812-825-4349

Provider Business Practice Location Address
First Line	:	1406 W. LAKE STREET # 208
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2653
Country	:	US
Telephone Number	:	612-642-1754
Fax Number	:	612-825-4349

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/01/2018

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