Provider Demographics
NPI:1972964153
Name:VOGT, TERRY L (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:L
Last Name:VOGT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 MURDOCH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2605
Mailing Address - Country:US
Mailing Address - Phone:314-303-5178
Mailing Address - Fax:314-768-7128
Practice Address - Street 1:6437 MURDOCH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2605
Practice Address - Country:US
Practice Address - Phone:314-303-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089823163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant