1144368648 NPI number — MS. MARY JILL VOGT L.C.S.W.,B.C.D.

Table of content: MS. MARY JILL VOGT L.C.S.W.,B.C.D. (NPI 1144368648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144368648 NPI number — MS. MARY JILL VOGT L.C.S.W.,B.C.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOGT
Provider First Name:
MARY
Provider Middle Name:
JILL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.,B.C.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144368648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3351 EASTBROOK DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525-5745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-482-3121
Provider Business Mailing Address Fax Number:
970-419-3185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1217 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
BUILDING 6
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-4040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-495-3453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  986037 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30570549 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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