Provider Demographics
NPI:1225179237
Name:LOGAN, KAREN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SHAWNEE LN
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4481
Mailing Address - Country:US
Mailing Address - Phone:801-391-6849
Mailing Address - Fax:
Practice Address - Street 1:3354 HARRISON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1296
Practice Address - Country:US
Practice Address - Phone:801-391-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13661335011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical