Provider Demographics
NPI:1811045123
Name:VOGELSANG, ELLEN M (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:VOGELSANG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 JOSLYN ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4992
Mailing Address - Country:US
Mailing Address - Phone:406-431-5930
Mailing Address - Fax:406-442-0594
Practice Address - Street 1:706 JOSLYN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4992
Practice Address - Country:US
Practice Address - Phone:406-431-5930
Practice Address - Fax:406-442-0594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT66676OtherBCBSMT PROVIDER SLP
MT530961Medicaid