Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003567140 |
---|---|
Provider Name | Vincent Vogt |
First Address | Milwaukee, WI 53202-1044 |
Second Address | Milwaukee, WI 53202-4808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2022 |
Last Update Date | 11/01/2022 |