Provider Demographics
NPI:1871106575
Name:VOGT, ELISABETH MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:MARY
Last Name:VOGT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:MARY
Other - Last Name:BRUZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-955-0660
Mailing Address - Fax:414-955-0076
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-291-2848
Practice Address - Fax:651-602-6885
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3868103G00000X
MN7090103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist