Provider Demographics
NPI:1801479647
Name:VOGT, NICOLE TAYLOR
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TAYLOR
Last Name:VOGT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:TAYLOR
Other - Last Name:SHUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33630 HIGHWAY RA
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-6014
Mailing Address - Country:US
Mailing Address - Phone:610-401-1328
Mailing Address - Fax:
Practice Address - Street 1:913 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1811
Practice Address - Country:US
Practice Address - Phone:573-378-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist