Provider Demographics
NPI:1871360156
Name:VOGRIN, MARISSA SUE (MA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:SUE
Last Name:VOGRIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:SUE
Other - Last Name:WENDLANDT-LAWM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 DEKALB AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3114
Mailing Address - Country:US
Mailing Address - Phone:815-258-6470
Mailing Address - Fax:
Practice Address - Street 1:66 MILLER DR STE 105
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5144
Practice Address - Country:US
Practice Address - Phone:815-655-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health