Provider Demographics
NPI:1346759529
Name:VOGEL, TAYLOR SHAE (BCBA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SHAE
Last Name:VOGEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:SHAE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1133 COLLEGE AVE STE E230
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2818
Mailing Address - Country:US
Mailing Address - Phone:785-587-1825
Mailing Address - Fax:785-587-1828
Practice Address - Street 1:6214 24TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3319
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:785-587-1828
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2024-06-02
Deactivation Date:2024-04-21
Deactivation Code:
Reactivation Date:2024-05-31
Provider Licenses
StateLicense IDTaxonomies
KSRBT-15-5248-27740106S00000X
KS1-23-70356103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBACB325715OtherBACB