Provider Demographics
NPI:1144973447
Name:VOGT, SOFIA J
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:J
Last Name:VOGT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24145 WESTSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-4873
Mailing Address - Country:US
Mailing Address - Phone:352-238-6071
Mailing Address - Fax:352-433-0845
Practice Address - Street 1:24145 WESTSHIRE CT
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-4873
Practice Address - Country:US
Practice Address - Phone:352-238-6071
Practice Address - Fax:352-433-0845
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services