Provider Demographics
NPI:1336482991
Name:LOGAN, FELICIA JEANNETTE
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:JEANNETTE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 RYAN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-4204
Mailing Address - Country:US
Mailing Address - Phone:405-388-8892
Mailing Address - Fax:
Practice Address - Street 1:5028 RYAN DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-4204
Practice Address - Country:US
Practice Address - Phone:405-388-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker