Individual provider Active NPI

Elizabeth P. Vogt, PSY.D.

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1619161783
Registry record updated Aug 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP5540 Issued in MN
Practice address
1406 W. Lake Street # 208
Minneapolis, MN 55408-2653
Phone
(612) 642-1754
Fax
(612) 825-4349
NPI assigned
Aug 31, 2007
Last updated
Aug 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X LP5540 MN Primary

Addresses

Primary practice location

1406 W. Lake Street # 208
Minneapolis, MN 55408-2653

Mailing address

1406 W. Lake Street # 208
Minneapolis, MN 55408-2653
Phone (612) 642-1754

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241122000532 MN Practitioner - Clinical Social Worker 4880129220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CGC LLCGroup PAC ID 4284169723, 9 clinicians

Practice addresses (Care Compare)

4208 Park Glen Rd
Minneapolis, MN 55416-4758
Phone (612) 825-4792

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
CGC LLC CurrentSince Oct 1, 2024 Accepting new patients

Locations

1406 W Lake St
Ste 208
Minneapolis, MN 55408
Phone (612) 642-1754

333 Washington Ave N
Minneapolis, MN 55401
Phone (612) 349-2797

4208 Park Glen Rd
St Louis Park, MN 55416
Phone (612) 825-4792

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1619161783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 W. LAKE STREET # 208",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082653",
            "telephone_number": "612-642-1754",
            "fax_number": "812-825-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 W. LAKE STREET # 208",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082653",
            "telephone_number": "612-642-1754",
            "fax_number": "612-825-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOGT",
        "first_name": "ELIZABETH",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-31",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.