Provider Demographics
NPI:1134318066
Name:KIM LOGAN COMMUNICATIONS CLINIC INC
Entity Type:Organization
Organization Name:KIM LOGAN COMMUNICATIONS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:JANISSE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,SPL
Authorized Official - Phone:313-898-8200
Mailing Address - Street 1:8313 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-2231
Mailing Address - Country:US
Mailing Address - Phone:313-898-8200
Mailing Address - Fax:313-898-2232
Practice Address - Street 1:8313 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2231
Practice Address - Country:US
Practice Address - Phone:313-898-8200
Practice Address - Fax:313-898-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1118869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty