Provider Demographics
NPI:1174032957
Name:LOGUE, REBECCA (LSWAIC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LOGUE
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 23RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5918
Mailing Address - Country:US
Mailing Address - Phone:443-540-9405
Mailing Address - Fax:
Practice Address - Street 1:929 N 130TH ST # ST3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7500
Practice Address - Country:US
Practice Address - Phone:443-540-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608874601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical